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Readers Write: Healthcare’s Hidden Cost Crisis: How Middlemen and Outdated Tech are Bankrupting America

November 18, 2024 Readers Write 1 Comment

Healthcare’s Hidden Cost Crisis: How Middlemen and Outdated Tech are Bankrupting America
By Navin Nagiah

Navin Nagiah, MS is co-founder and CEO of Daffodil Health.

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Recent articles, including those in The New York Times, have shone a spotlight on how middlemen contribute to rising healthcare costs, notably out-of-network (OON) pricing companies like MultiPlan and pharmacy benefit managers (PBMs), whose fees often obscure and inflate costs. While these analyses are thorough, they often focus on single facets of a sprawling, deeply rooted problem.

The truth is more intricate and defies simplistic solutions. High costs in US healthcare have accrued over decades, shaped by actions across the board, from government policy to insurer practices, provider pricing, and patient behavior.

The presence of intermediaries such as PBMs, OON re-pricing firms, and healthcare consultants reflects the US healthcare model’s structural complexity. As a hybrid of public, private, and even cash-based systems, it has produced a $4.1 trillion industry — 22% of the total economy — where $1 trillion alone goes toward administrative costs, with an estimated $500 billion of that deemed unnecessary or wasted.

For ordinary Americans, this complexity translates into hardship. Forty-one percent are burdened with medical debt; 46% forgo needed care due to cost; and 58% of debt collection involves medical bills. This financial strain is unsustainable for individuals, society, and the nation at large.

An underlying issue is healthcare pricing, which is inelastic, opaque, and tethered to outdated systems. Unlike typical markets, healthcare prices in the US do not respond to supply and demand. The pricing framework is labyrinthine, requiring deep domain expertise to navigate tens of thousands of procedural codes and varied pricing methods. Additionally, administrative systems used by both payers and providers often rely on outdated technology, exacerbating inefficiencies.

However, this does not make the primary actors — whether insurers, providers, or third-party entities — the villains of the story. In a capitalist framework, each stakeholder is incentivized to prioritize revenue and profits. Healthcare is no exception. It’s probable that any rational actor in similar roles would make comparable decisions.

The question we must address is: How do we move forward? What changes are necessary to begin mending this broken system?

The solution demands both regulatory and technological reform. First, let us take a closer look at regulation, where bipartisan consensus on the need for reform offers rare common ground. The No Surprises Act, for instance, was enacted under one administration and implemented by another, underscoring shared political will to mitigate healthcare’s impact on everyday Americans. Yet if we are to achieve genuine change, regulatory bodies need to adopt a more thoughtful and strategic approach.

Understand the market dynamics of payers and providers

Insurers and providers operate with the goals of revenue and profit growth, which regulators and regulations often fail to consider. Laws that don’t account for potential loopholes simply shift costs rather than reduce them, creating the illusion of progress. It is imperative to keep in mind that rising healthcare costs implies higher revenue for providers; a higher revenue for providers means higher premiums, i.e. revenue for payers.

The stock market rewards revenue growth way more than improved margins. This provides extensive incentive to payers and providers to be innovative in how they “shift costs” when regulations are passed.

Regulation must be crafted with an understanding of its potential impact on healthcare costs for ordinary people, avoiding the squeezed balloon effect, where costs shift without any overall cost reduction.

Recognize healthcare’s local monopolies

While other sectors, like technology, are subject to national antitrust scrutiny, healthcare operates across many local micro-markets with localized monopolies. Regulation should reflect this structure, addressing these micro-monopolies with tailored policies that account for regional market dynamics.

Stop adding to the middlemen problem

Regulations must be enacted with caution to avoid inadvertently inflating the healthcare sector’s administrative footprint. The Transparency in Coverage Act, for example, while intended to increase transparency, has spawned a cottage industry of compliance tools companies and consultants — more middlemen — with minimal impact on consumer costs. Future regulations should include clear expectations and mechanisms for affordable, effective compliance without adding new categories of middlemen to the already bloated system. Additionally, regulatory enforcement should be robust, ensuring that non-adherence results in significant penalties that deter cost-shifting practices.

Without these considerations, regulatory measures may perpetuate the inefficiencies they aim to resolve. Now more than ever, Americans need a healthcare system that prioritizes access, transparency, and genuine affordability. Legislative reform, combined with strategic enforcement, could be the first step toward this elusive goal.

Second, let us take a closer look at technology. Once a system, any system, reaches a certain level of complexity, simplifying it again becomes a near-impossible task. However, technology offers a pathway to managing complexity in ways that improve usability and efficiency. Consider the internet. It’s an enormous, convoluted system, yet search engines allow us to find information quickly and (usually) accurately.

In healthcare, however, technology has so far largely added to both complexity and the cost burden rather than easing it. Generative AI could mark a turning point. This technology is unique in its ability to emulate human skills like storytelling, a talent that was once thought exclusive to humans, which helps achieve shared understanding and collaboration. The potential is enormous. AI systems can now analyze, interpret, and convey information much like a human, which could impact healthcare administration, a sector valued at $1 trillion, half of which is estimated to be wasteful expenditure.

Take the process of claim re-pricing and payment as an example. After a doctor generates a bill for reimbursement, that claim may pass through as many as 10 companies and 12 software systems, each with its own requirements and procedures, before the doctor is paid. This labyrinthine process stems from decades of regulations, changing market dynamics, and piecemeal ad hoc solutions. Yet by deploying Generative AI and semi-autonomous agents, we could digitize and automate this entire process from end to end, significantly cutting down on time, costs, and redundancies.

Similar opportunities exist across other healthcare administration processes, whether in prior authorizations, member enrollment, or patient management. I am not suggesting that technology or Gen AI is a silver bullet. This is a long-term undertaking, demanding deep expertise in both healthcare and technology, a rigorous attention to detail, and considerable patience. Still, nothing in the nature of the problem makes it unsolvable.

Companies routinely embark on “moonshot” projects that demand decades to bear fruit, like Facebook’s Metaverse, Elon Musk’s SpaceX and Neuralink, and Google’s Waymo, Wing, and Loon. These projects capture public imagination and dominate media cycles, but moonshots in healthcare administration, though less glamorous, offer far greater potential for transforming lives.

We need to encourage visionary entrepreneurs to pursue these difficult challenges within healthcare. Initiatives that, though unglamorous, offer substantial benefits to consumers and society at large. Government support is also crucial. Legislation that promotes competition within local healthcare markets and policies that encourage innovative solutions for complex healthcare issues would drive meaningful progress.

Readers Write: Tackling Diabetes Distress in Dual Eligibles Requires Integrated Care Management

November 18, 2024 Readers Write Comments Off on Readers Write: Tackling Diabetes Distress in Dual Eligibles Requires Integrated Care Management

Tackling Diabetes Distress in Dual Eligibles Requires Integrated Care Management
By Barbara Greising

Barbara Greising, MBA is chief commercial officer at Podimetrics.

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Diabetes is a demanding condition. Slipping up even a little can quickly lead to devastating outcomes, and there’s never, ever a day off. 

The constant stress can lead to feelings of discouragement, isolation, frustration, and exhaustion, especially when the consequences of suboptimal self-management can be so severe. For example, every 3.5 minutes, someone in the US loses a limb due to complications of type 2 diabetes (T2D), and up to 50%of those individuals may face death as a result within just two years.

For people living with diabetes and behavioral health challenges, such as a large number of the socioeconomically complex dual-eligible Medicare/Medicaid (DE) population, the outcomes could potentially be even more catastrophic, with mortality risks up tofour times higherthan people with either condition alone.

Up to 45% of mental health conditions and cases of severe psychological distress go undetected among people being treated for diabetes. And with nearly a third of DEs experiencing a serious mental health disorder of some kind, including major depression, that’s a potentially huge number of high-needs people who are not getting appropriate care.

Without proactive, personalized mental health support for these individuals, “diabetes distress” can take root, leaving up to half of people with diabetes feeling overwhelmed, defeated, disengaged, and less equipped to manage their everyday needs at some point in their health journey.

It is crucial to understand the root causes of diabetes distress, particularly in high-risk, highly complex DE populations, and develop proactive, personalized strategies rooted in integrated case management techniques that merge effective mental healthcare resources and socioeconomic support with more traditional approaches.

The first step for assisting people with diabetes is knowing if they need help. Standardized questionnaires like thePHQ-9 can be helpful, but these tools are not usually designed to uncover diabetes-specific concerns, nor are they always used at the most effective points in the diabetes management process.

Providers and health plans may consider augmenting data collection efforts with more targeted measurement tools for diabetes distress, such as the American Diabetes Association’s Problem Areas in Diabetes (PAID) Scale. This check sheet asks detailed questions, such as if the person feels scared, angry, or discouraged when thinking about living with diabetes, what their support system looks like, and how much energy diabetes care takes from them each day.

Providers should also look at patient barriers from every angle to reveal hidden challenges. For example, when one patient stopped engaging in daily self-monitoring for diabetic foot ulcers, it wasn’t because she didn’t understand the importance. It was because she couldn’t get to her doctor’s office to get a refill of her blood pressure medication. The frustrating situation and negative health effects from being off her meds meant she wasn’t feeling able to take care of herself fully.

When the patient received help to get connected with plan-based home care benefits to see a primary care provider for a refill, she reengaged with her foot care immediately, and at the same time, avoided an ED visit for potential hypertension complications.

Regularly fielding holistic questions about self-care competencies in the routine primary care environment is important, but plans and providers should also consider refreshing their data at other key points, such as during specialty visits for associated complications and before discharge from a hospital due to a diabetes-related event. This can ensure that individuals get the help they need when they need it, before diabetes distress becomes overwhelming.

Case managers can assist with this process by spearheading the development of compassionate, informed patient-provider and/or member-health plan relationships. These care team “quarterbacks” can help connect individuals with social workers, psychologists, psychiatrists, substance abuse counselors, and other behavioral health professionals to augment clinical care. 

Case managers, especially those with nursing backgrounds, often have the training, intuition, and experience to identify people who may be struggling with a variety of non-clinical concerns and can successfully pair these insights with their clinical knowledge of diabetes management to support and guide people with diabetes to better glycemic control and improved overall mental health and well-being.

To be effective, however, case managers must be equipped with the tools and resources to perform this work appropriately. For example, health plans and provider networks will need to ensure that high-quality mental health resources, such as patient support programs, social workers, and counseling options, are consistently available for referral in a timely and affordable manner. 

Case managers also need digital infrastructure to make referrals to socioeconomic support organizations, monitor the use of personal medical devices like continuous glucose monitors, and interact with individuals according to their preferred communication channels.

Diabetes distress is not a condition that can be wholly cured by a single pill or one-and-done injection. Instead, it requires ongoing attention and flexible degrees of management to establish and maintain emotional and mental equilibrium in the face of prolonged stress.

That means Medicare and Medicaid health plans, providers, case managers, patients, and unpaid caregivers must collaborate closely at all times to build a scaffolding of support around every individual.

Care team leaders should ensure that people with diabetes understand how, when, and why to use their medications and personal devices, especially when adding new technologies to the mix. Regular follow-ups around socioeconomic concerns and mental health status will be essential to success, including periodic refreshes of questionnaires and other patient-provided data. Health plans, health networks, and other industry stakeholders will need to remain dedicated to expanding access to mental and behavioral healthcare resources, especially in communities with a higher prevalence of diabetes.

By collecting the right information and getting people connected to the most appropriate resources for their needs, case managers can reduce the impact of diabetes distress on dual-eligible individuals and create the conditions for success for the tens of millions of people living with diabetes.

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Morning Headlines 11/18/24

November 17, 2024 Headlines Comments Off on Morning Headlines 11/18/24

Upheal secures $10M to help reduce provider burnout and improve client outcomes with their AI-powered platform

Upheal, which offers a clinical documentation personal assistant for mental health professionals, raises $10 million in a Series A funding round.

DEA and HHS Extend Telemedicine Flexibilities through 2025

The DEA and HHS will extend telemedicine prescribing flexibilities for an additional year.

HealthLynked Corp. Announces Third Quarter and Year-to-Date 2024 Results with Strategic Restructuring, Third-Party Debt Repayment, and Core Technology Focus

Urgent care telehealth provider HealthLynked reports Q3 results: revenue down 56%, EPS –$0.01 versus $0.00.

Comments Off on Morning Headlines 11/18/24

Monday Morning Update 11/18/24

November 17, 2024 News 4 Comments

Top News

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Södra Älvsborg Hospital in Sweden pauses its use of the recently implemented Oracle Health Millennium. The regional director apologized, acknowledging that “the introduction has not gone according to plan.”

Specific user complaints include system slowness as well as displaying incorrect diagnoses, such as changing “no bleeding” to “bleeding.”

Hundreds of employees staged a demonstration to return to the old system, citing decreased efficiency and patient safety. Västra Götalands Medical Association is considering taking legal action over patient safety risks.

The previous system has been reactivated and some functions have been moved back to paper while Millennium problems are being addressed.

According to one chief physician, “It’s a lousy system that’s completely impossible to work in. These days, I’ve basically been unable to produce any healthcare.”


Reader Comments

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From Lanman: “Re: AblePay. Do any readers know anything about it? My big health system says that those who can’t pay will get assistance, while those who can ‘may’ save up to 13%. Anyone know if it is legit / good idea?” The company’s website says that it contracts with providers at higher rates, provides members with cards with AblePay as the secondary payer, and guarantees that providers will be paid within two weeks of billing. Online member reviews are mixed, with one saying that it’s better to ask the hospital for a cash discount from rack rates or use the hospital’s no-interest payment plan instead of giving AblePay a credit card number that they will charge immediately. Your comments are welcome, especially if you have AblePay experience as a patient or provider. 


HIStalk Announcements and Requests

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Poll respondents like Madison as the US’s health tech capital. A couple of folks questioned why a Cerner-less KCMO or Minneapolis weren’t listed as choices.

New poll to your right or here: Have you taken a consumer DNA test such as Ancestry or 23andMe? Several of my acquaintances, especially older ones who were raised in different cultural times, have been shocked to find evidence of previously unknown siblings, learned that they were raised by someone who wasn’t their biological parent, or saw strong indications of being the result of incest.

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I funded some new Donors Choose teacher grant requests using money that was provided by my Anonymous Vendor Executive, who is happy to offer a 1:1 match on your donation that you can submit as below. Companies that donate a matchable $1,000 will receive a couple of sentences in an HIStalk news post to convey any message they choose (a company pitch, for example).

  • Purchase a gift card in the amount you’d like to donate.
  • Send the gift card by the email option to mr_histalk@histalk.com (that’s my Donors Choose account).
  • I’ll be notified of your donation and you can print your own receipt from Donors Choose for tax purposes.
  • I’ll pool the money, apply all matching funds I can get, and publicly report here the projects I funded, including occasional teacher follow-up messages and photos.

These are the new, fully funded projects, all of which involved historically underfunded schools in which at least 50% of students come from low-income households:

  • Weeding tools for the ecology club garden of Ms. M’s middle school class in Hawthorne, CA.
  • Headphones for Mr. G’s elementary school class in Pasadena, TX.
  • STEM kits for Ms. M’s middle school class in Moreno Valley, CA.
  • Microphones and speaker for Ms. B’s elementary school math and science class in Kinston, NC.
  • STEM supplies for Ms. M’s elementary school class in Seguin, TX.
  • Electric car microcontrollers for Mr. P’s high school physicians and robotics classes in Brooklyn, NY.
  • Math manipulatives for Ms. A’s kindergarten class in Sussex, VA.
  • A voice amplifier for Mr. M’s preschool class in Dallas , TX.
  • Flexible seating for Ms. H’s elementary school class in Port Saint Lucie, FL.
  • An LED aquarium hit for Ms. G’s high school AP biology and environmental science classes in Savanna, GA.

A Reader’s Notes from the CommonWell Fall Summit, November 4-5, Nashville

General Overview

  • Thirteen new CommonWell members in the past year (several appear to be general members rather than service adopters). The network now consists of 37,000+ providers, 248+ million individuals (primarily adults), and 9 billion health records retrieved. Currently seeing about 0.5 billion records (documents) exchanged each month.
  • Labcorp is a newer member and is pushing CommonWell towards more discrete data exchange via FHIR. Labcorp will be an exception in the network in that it will only respond in FHIR format.

Product roadmap

  • Individual Access Services (patients requesting their records) through FHIR is currently in testing. Will still be document-based through the exchange of FHIR DocumentReferences and Binaries.
  • They have implemented passive indexing, which tracks the locations that have attempted to find a patient’s records. This gives them a sense for where the patient has been treated and, therefore, where you could go look for treatment-related records later on.
  • Expecting to support the Healthcare Operations Exchange Purposes under TEFCA by the end of the year. Additional Exchange Purposes will be supported in the first half of 2025.
  • Replacing their legacy Event Notification System with a new ADT & Patient Alerts framework; the latter will allow consuming systems to subscribe to updates when a patient has certain activity, such as a new link to an organization in the network.

TEFCA

  • Additions to the TEFCA directory have been paused for several weeks due to concerns around vetting of participants. There is a new Vetting Process SOP coming out very soon to define a process for vetting participants, and the hope is that directory additions can resume by the end of November. (Of course, as I draft this email, the SOP is published.)
  • The SOP involves a series of steps to follow, which vary based on the kind of provider being onboarded. It governs how QHINs submit a participant for inclusion in TEFCA and how other QHINs can object.
  • Anyone already in TEFCA must still go through the vetting process, though they can continue to query through TEFCA while that plays out.
  • Through August 2024, TEFCA has seen 486 million patient searches (this is an inflated number since each patient search hits every QHIN and therefore is counted multiple times), 4.9 million document queries, and 2.5 million document retrievals.
  • In September 2024, CommonWell specifically saw 30.6 million patient searches from Epic, 547,000 from KONZA, and 12 from Kno2.
  • Average response time to patient searches by QHINs varies, from as little as 40 ms to as much as 6455 ms.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.


Acquisitions, Funding, Business, and Stock

WellSky releases SkySense, AI-powered tools for its EHR sollutions that extract key information, perform ambient scribing, and summarize chart data.

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Upheal, which offers a clinical documentation personal assistant for mental health professionals, raises $10 million in a Series A funding round.

Urgent care telehealth provider HealthLynked reports Q3 results: revenue down 56%, EPS –$0.01 versus $0.00. HLYK shares have lost 12% in the past 12 months, valuing the company at $11 million.


People

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UT Health San Antonio promotes Michael Schnabel, MBA  to VP/CIO.

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Pete D’Addio, MS (Moffit Cancer Center) joins LCMC Health as VP of technology.


Announcements and Implementations

Truveta Data says that its  EHR-sourced database contains the de-identified records of 120 million patients.


Government and Politics

ProPublica calls out the lax enforcement of state regulations that require insurers to keep their provider directories current. A previous New York study of “ghost networks” found that 86% of the listed mental health professionals had incorrect contact information, weren’t actually in the stated network, or weren’t accepting new patients.


Sponsor Updates

  • Five9 expands its partnership with ServiceNow to deliver a turnkey, AI-powered solution combining Five9’s Intelligent CX Platform with ServiceNow’s Customer Service Management.
  • Rheumatology Associates of Oklahoma reports significant time savings using EClinicalWorks AI Assistant for Images.
  • WellSky adds SkySense, a new suite of AI-powered tools designed to increase operational and clinician efficiencies, to its EHR systems.
  • Nordic releases a new “Designing for Health” podcast, “Interview with Graham Walker, MD.”
  • CHIME honors Optimum Healthcare IT with the 2024 CHIME Foundation Partner Award.
  • RLDatix will sponsor and present at the ACHE Scottsdale Cluster November 18.
  • Sectra receives a CSA STAR Level 2 security certificate, facilitating cloud adoption in healthcare.
  • Visage Imaging is featured in a new video titled “The Imaging Wire Show – The Road to Cloud-Based PACS.”
  • SmartSense by Digi achieves SOC 2 Type II compliance.
  • Sonifi Health releases a new e-book, “Reimagining Patient TVs.”
  • TrustCommerce, a Sphere Company, publishes a new e-book, “TrustCommerce Community Connect Program.”
  • Tegria publishes a case study, “Azure Data Lakehouse Enables Higher-Visibility Reporting Across Data Sources.”
  • Spain’s Health Ministry renews its agreement with Wolters Kluwer Health for UpToDate clinical decision support solution.
  • Agfa HealthCare, Artera, Elsevier, QGenda, Sectra, Visage Imaging, and Wolters Kluwer Health will exhibit at RSNA December 1-5 in Chicago.

Blog Posts


Contacts

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

Morning Headlines 11/15/24

November 14, 2024 Headlines Comments Off on Morning Headlines 11/15/24

Impilo Secures Series A Funding! Looking to Transform Healthcare Access Nationwide

Remote care software and services startup Impilo announces $11.5 million in Series A funding.

WashU Medicine, BJC Health System launch Center for Health AI

Washington University School of Medicine and BJC Health System in Missouri develop the Center for Health AI, which will develop and deploy healthcare AI technologies to improve patient care, streamline clinical workflows, and reduce administrative burdens.

Landmark Agreement Signed by Governor Albert Bryan Jr. to Share Data and Transform Care Coordination and Care Delivery for US Virgin Islanders

The US Virgin Islands Office of Health Information Technology will work with CRISP Shared Services to develop an HIE.

Comments Off on Morning Headlines 11/15/24

News 11/15/24

November 14, 2024 News 1 Comment

Top News

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Forward, a primary care delivery company that brought AI-powered doc-in-a-box CarePods to market last November, abruptly shuts down. Current patients will have access to care support until December 13, according to an announcement posted on what’s left of the company’s website.

Former employees said key problems were lack of patient interest, skeptical commercial building landlords, blood draw technology failures that forced the company to stop offering lab tests, and machines that left patients stuck inside.

Forward managed to install just five of the devices, which cost $1 million each to build.

My analysis of the original announcement, especially given the history of Forward’s predecessors and comments made by its members, wasn’t optimistic.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.


Acquisitions, Funding, Business, and Stock

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Babylon Health founder Ali Parsa, PhD launches healthcare AI assistant company Quadrivia with seed funding from a Swedish VC firm. (A bit of a health kiosk-related side note: Babylon, which shut down last year, acquired Smart Health Station vendor Higi for $5 million in 2022.)

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Impilo raises $11.5 million in Series A funding. The company offers white label remote care software and support services.


Sales

  • The US Virgin Islands Office of Health Information Technology will work with CRISP Shared Services to develop an HIE. The organizations launched an interoperability pilot program last year.

People

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Thomas Elbert (Health Catalyst) joins Get Well as COO.


Announcements and Implementations

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Niagra Health in Ontario goes live on Oracle Health.

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Sentara Norfolk General Hospital (VA) implements Andor Health’s ThinkAndor virtual nursing technology.

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UConn John Dempsey Hospital (CT) rolls out 15 video monitoring camera carts as part of its new telesitter program.


Government and Politics

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A new report from the Government Accountability Office points out that HHS has failed to act on several GAO cybersecurity recommendations made earlier this year. It stresses that the department must do a better job of coordinating and monitoring ransomware mitigation efforts and tracking provider adoption of cybersecurity practices so that it can better determine the need for cybersecurity resources.

The Defense Health Agency and US military hospitals in Japan warn patients of a website masquerading as the MHS Genesis patient portal that attempts to direct visitors to download a non-existent MHS Genesis mobile app. The DHA Cyber Operations Center has since blocked the fake site, which uses a .info rather than .mil web address.


Other

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A study of primary care appointments at five VA clinics reveals that physicians often don’t digitally document what patients discuss with them during the visit. Physician-initiated concerns were included in 92% of EHR notes, while just 45% of patient-initiated discussions were documented. Researchers also noticed that nearly 50% of notes found in the EHR for these appointments were not found in visit transcripts.


Sponsor Updates

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  • Cardamom Health team members volunteer with non-profit Rise Wisconsin, helping it to prepare for the 45th anniversary celebration of its Respite Center.
  • Artera’s government solutions business promotes Kari Baldonado to general manager and Marsha Laird-Maddox to senior director of strategy and operations; and names Matt Beirne (Cerner) director of federal growth and strategy.
  • Arcadia launches new product modules, Enhanced Benchmarks and Vista Push, and previews upcoming solutions to further enable success with value-based care.
  • Zuckerberg San Francisco General Hospital expands its Agfa HealthCare enterprise imaging system to its cardiology department.
  • Inovalon promotes Sandy Warford to director of product marketing.
  • Five9 expands its Genius AI suite with the launch of AI Agents, the next-generation of Five9 Intelligent Virtual Agents, which incorporates generative AI.
  • Healthmonix congratulates Houston Methodist on its achievement in the Medicare Shared Savings Program, as recognized by CMS.
  • Lucem Health names Mansi Goel (Johns Hopkins) associate data scientist.
  • Meditech congratulates Ozarks Healthcare hospitalist and CMIO Priscilla Frase, MD on being recognized as CHIME’s Innovator of the Year.
  • Altera Digital Health becomes a member of the The Sequoia Project.
  • Visage Imaging publishes a new white paper, “Progress Towards Cloud: Relief, Considerations and New Opportunities.”

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 11/14/24

November 14, 2024 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 11/14/24

I have a couple of medical licenses that expire at the end of the year, so I spent some time taking care of those renewals. Failing to renew on time is an expensive mistake that can cause issues with credentialing and can result in disciplinary action if you inadvertently practice in a state where you’re not current. Although I rely on my clinical employer’s credentialing team to remind me, I also have appropriate reminders on my personal calendar to ensure I don’t miss a critical deadline. Most states where I’m licensed allow online renewal and the process takes only a few minutes, as long as there are no changes to your address, no new criminal convictions or malpractice claims, and you have a valid credit card.

As I was wrapping up it was a good reminder to make sure that all my professional memberships were renewed as well, so that they could be in the books for the 2024 fiscal year. Although most of those run January through December, I realized that my HIMSS membership had expired during the summer and either I missed it, or I didn’t receive a reminder. I guess I didn’t notice because I receive plenty of emails from HIMSS on a near-daily basis, and wouldn’t one think they’d suspend communications if you’re not paying dues? I would also think they’d send multiple reminders before expiration and continue to send reminders after, since HIMSS membership renews on a rolling basis. There was no penalty for late renewal and in fact my expiration date shifted, so it was like getting four months of membership for free since nothing had changed, at least in my opinion. I suspect that individual memberships like mine are the lowest thing on the organization’s priority list, so I shouldn’t be surprised. I’m not sure how valuable a HIMSS membership is anymore – maybe some readers should weigh in on how I could be getting more from my money than a discounted HIMSS conference registration rate.

From Jersey Girl: “It’s not just the WNBA – a health system logo is going to be featured on an NBA jersey for the first time.” Congratulations to Memorial Hermann Health System, whose patch will appear on Houston Rockets jerseys this season. The system already owns naming rights for the team’s training center, so it’s not surprising. A quick assist from Chat GPT tells me that patch rights go for $7M to $10M each year, so I hope the health system is going to get some significant return on its investment. That’s a lot of community health screenings or discounted health services that could be provided with that kind of money. Are you a health system exec willing to speak off the record about what these deals mean to your institution? Feel free to reach out anonymously.

AI is everywhere, so I was interested to see this recent JAMA Viewpoint article titled “Translating AI for the Clinician.” Most of my local colleagues think of AI as “using Chat GPT to write patient letters,” but don’t think too far beyond that. The authors note the need for a framework “for clinicians and patients to understand AI in the context of clinical practice, including the evidence of efficacy, safety, and monitoring in real-world clinical use.” I’ve been on the patient side of AI-augmented patient portal responses and ambient documentation, and during zero of those encounters has there been any mention to me as a patient about the use of AI or the risks and benefits of consenting to it being used as part of my care. As a clinical informaticist I know better – but the situation illustrates the need to better educate clinicians on the need to have some kind of a consent process around the use of these tools. The authors call for organizations to spend time considering the different activities inherent in patient care – elements such as interacting with patients, creating visit notes, interpreting tests, and delivering treatments – and to think about the best ways to leverage AI in those scenarios. This sounds like a rational approach to me – actually identifying a problem to solve versus creating a solution in search of a problem. Although many of the current uses of AI are well-reasoned, there are still a number of startups addressing the latter.

I’ve not used ambient documentation solutions as a clinician, so I reached out to a couple of friends to find out how their organizations are handling consent. One admitted that they addressed it during the pilot phase, but that by and large physicians just want it installed and are assuming that it’s addressed in the standard “consent to treat” forms that patients sign at the front desk or online via the patient portal. The only person who is actively having a consent conversation is a pediatrician, where the idea of consent is a big issue in general due to nuances of privacy and confidentiality when you’re caring for adolescents. Learning more about this topic reminded me how broad of a field clinical informatics has become and how one informaticist can’t possibly know everything. Although most large institutions have entire teams tackling these issues, the average physician trying to purchase an individual contract from one of the AI documentation vendors probably doesn’t know what questions to ask. The authors call for organizations to treat AI like they treat new drugs or medical devices – with testing and follow up to ensure that treatments are effective. Unfortunately, millions of patients are already part of a large experiment without even knowing it.

The Anchorage Daily News reports that nurses are concerned about the implementation of virtual nursing in their communities. I’ve worked on a couple of virtual nursing projects in the last few years, and they’ve generally been well received, so I was interested in the specific concerns. Nurses are concerned that having virtual colleagues managing discharge planning and patient education will concentrate additional work on the bedside nurses, stressing an already burdened work force by driving up patient-to-nurse ratios. The nurses’ union has filed a complaint with the National Labor Relations Board alleging unfair labor practices, so it’s not a concern that will go away any time soon. Hospital nursing has changed dramatically during the time between when I was a student and today, and frankly the only constant about patient care is that it will continue to change. The article notes that unlike some states, Alaska does not have a mandated patient-to-nurse ratio. I’ll be keeping an eye on this one to see how the labor complaint plays out.

Do you have virtual nursing at your institution and if so, how has it been received? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on EPtalk by Dr. Jayne 11/14/24

Morning Headlines 11/14/24

November 13, 2024 Headlines Comments Off on Morning Headlines 11/14/24

Inside Forward’s failed attempt to revolutionize the doctor’s office

AI-powered doc-in-the-box manufacturer Forward shuts down after an eight-year run, during which it raised $650 million.

The Future of Telehealth.org with Doxy.me

Telemedicine software developer Doxy.me acquires professional development and consulting organization Telehealth.org.

Harvard Medical School Alum Donates $6 Million for AI Health Care Education

Inovalon founder and CEO Keith Dunleavy, MD donates $6 million to his alma mater, Harvard Medical School, to expand education in AI in healthcare.

HHS has still not addressed key cyber recommendations, GAO says

A new report from the Government Accountability Office points out that HHS has failed to act on GAO cybersecurity recommendations made earlier this year, and stresses that the department must do a better job of coordinating ransomware mitigation efforts and tracking provider adoption of cybersecurity practices.

Comments Off on Morning Headlines 11/14/24

Healthcare AI News 11/13/24

November 13, 2024 Healthcare AI News Comments Off on Healthcare AI News 11/13/24

News

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Google launches Learn About, a conversational AI learning companion that helps users learn about any topic.

Inovalon founder and CEO Keith Dunleavy, MD donates $6 million to his alma mater, Harvard Medical School, to expand education in AI in healthcare. 


Business

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AI-powered doc-in-the-box manufacturer Forward, which said at the November 2023 launch of its CarePod that it hoped to deploy 3,200 of the machines in the next year, shuts down. The company had raised $650 million in funding. Former employees said key problems were lack of patient interest, skeptical commercial building landlords, blood draw technology failures that forced the company to stop offering lab tests, and machines that left patients stuck inside. Forward managed to install just five of the devices, which cost $1 million each to build. My analysis of the original announcement wasn’t optimistic.

Maverick Medical AI launches CodePilot, which offers real-time medical coding and MIPS/MACRA compliance notifications. 

Apple is preparing to launch its first AI hardware device, an Echo-like wall mounted smart display for homes that will allow users to control apps, use FaceTime as an intercom, play music, and eventually to operate a robotic arm.


Research

Johns Hopkins researchers train a robot by showing it videos of surgical procedures, after which the da Vinci Surgical System robot performed as well as a human doctor in manipulating a needle, lifting tissue, and suturing. The imitation learning involved videos that were recorded on cameras that were attached to da Vinci robots all over the world. The robot even learned behaviors that weren’t contained in the videos, such as picking up a dropped needle.

Researchers use AI-analyzed computer vision to predict neurological changes in NICU babies.


Other

A UCSD hospital neurology ICU nurse who is also the nursing union rep says that he is terrified by “the creep of AI in our hospitals.” He observes:

  • A billionaire Qualcomm executive funded the hospital’s new construction, a technical connection that he speculates as to why “they dive headfirst into this AI thing.”
  • The hospital replaced an Epic patient acuity application with an AI-based one that he says “felt like magic, but not in a good way” because it eliminated nurse involvement and didn’t explain its logic.
  • He says that ambient documentation is like mass surveillance that will be used to “track nurses” as was done with RFID tracking tags.
  • He concludes that the real goal of applying AI isn’t patient safety, but to increase nurse efficiency and make them “operators of the machines.”

Contacts

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

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HIStalk Interviews Lauren Patrick, CEO, Healthmonix

November 13, 2024 Interviews Comments Off on HIStalk Interviews Lauren Patrick, CEO, Healthmonix

Lauren Patrick is president and CEO of Healthmonix.

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Tell me about yourself and the company.

I am an IT engineer kind of person by training. I spent about 15 years working for consulting companies such as Capgemini and E&Y. I founded Healthmonix when I moved to Philadelphia about 15 years ago and wanted to do something more meaningful than selling tickets on the internet or compiling part lists for engineering firms.

Healthmonix is a healthcare analytics company that primarily focuses on quality metrics, with the MIPS and MSSP programs in particular. We got our start developing quality measures before everybody came to know what they were. I started working with the University of Pennsylvania to put together some CME programs. To figure out where the gaps in need were, we started using the Epic system to figure out what physicians knew and maybe what they didn’t know, then worked to provide performance improvement.

We work on quality metrics and now cost metrics as well, then help providers improve in those areas.

How do practices work and think differently in a value-based care model?

Rather than looking at fee-for-service — where every time you provide a service to a beneficiary or a patient, you are figuring out how to bill for that – it is focused on how to best take care of that patient, how to best serve that patient’s needs, and how to understand what that patient wants from their care.

How do you support practices that may have a mix of value-based and fee-for-service, or that work with multiple value-based care programs?

We take in all of the data for all patients. For the Medicare quality reporting program in particular, you have to report on all of your patients. No matter who the payer is – self-pay, private, Medicaid, or Medicare — all of those patients have to be included in your quality metrics panel in order to report to Medicare and get the incentives or avoid penalties. We track what their insurance is and can partition that data. We can show you quality metrics of your Humana patients versus straight Medicare fee-for-service patients.

We’re bringing all that data in, putting it in a repository, and then saying, here are the quality metrics that Medicare really cares about. We can show you those metrics from that data. Because of the way that we’ve built the software, we can also take that data and show you quality metrics that perhaps apply to Humana. We can take that same repository of information and pull it out in all the different ways for different reporting that is required. That’s quite a challenge, but that’s part of the beauty of coming at it from a data-based perspective. We pull all that data in and then build those quality metrics to help these folks report out with as little burden as possible.

How do physician behavior and education fit in?

While payment drives a lot of the participation in our programs, I started out working with UPenn trying to figure out how we could help providers improve. At the heart of what I want to do personally is to make a difference and help these people improve. But sometimes doctors will see these quality metrics put up on a screen somewhere and they will say, “No, these are wrong.”

We say, OK, let’s drill into them. Let’s take a look. This is the quality metric. You agree that this should be the standard of care, right? Let’s look at how your patients are or are not adhering to that. From there, you have to softly get these physicians into it. We’ve taught our physicians that they are knowledgeable and are out there making day-to-day decisions. To say to them, “Maybe you need to do something different“ is really a little bit of a shock to their system. It’s a standard cycle where they don’t believe, then they accept it, and then they have to figure out how they can change.

Is it enough to provide convincing data, or does change require having people on the ground to nudge them?

It depends on the personality of the physician. It also depends on the metric. You have to make sure that the measures that you’re putting in front of them are meaningful and something that the doctors can buy into.

When we started, we were looking at A1Cs. Let’s get the A1Cs down under fill in the blank – some doctors feel that nine is appropriate, some feel that seven is appropriate. Figuring out what that metric is, getting everybody to agree to that metric, and then having them work towards that. If they feel like it’s the right quality measure, then they are much more willing to work towards it.

When we do this, we look at process measures, which would be like filling out a prior auth or making sure that you put the meds in the EHR or whatever. But it’s the outcome measures that we are all striving for. Let’s make sure that our patients’ diabetes is in control. Let’s make sure their blood pressure is in control. Let’s make sure that they can walk out of the emergency department healthy. Let’s make sure that the patient’s objectives, in terms of what they want, are being adhered to. If you put the right metrics in front of these docs, they are much more willing to buy in, but you read journal articles all the time about how doctors don’t like a lot of the metrics that are being imposed by some of these programs.

What challenges are involved with collecting data from multiple systems and then packaging it together so that it is reliable?

That’s probably one of the biggest challenges industry-wide. We work very hard to pull data out of a variety of systems. Part of the challenge that we have now is that we might be reporting for not just an individual practice, but for an accountable care organization, which is a group of doctors that have banded together to say, “We are going to take responsibility for making sure that Mrs. Jones is healthy.” We have to pull all the data from all of those various practices and put it into one dashboard. We have to say, these are the outcome measures for Mrs. Jones, and who is working on that?

It’s hard to pull that data together because some of it is in an Athena system, some is in an Epic system, and some is in a billing system. Bringing it all together is one of the biggest challenges. We don’t just bring in a file, dump it, and say we’re done. We work with providers to understand where they are putting the data. A lot of times one doctor will put it in one field and another doctor will put it in a different field, so we have to understand that we have to get it from both fields. We spend a lot of time on data integration.

Has 21st Century Cures and broader interoperability improved that, or will it in the future?

That’s the dream. Everybody keeps saying FHIR, bulk FHIR, and all the regs that have come out. But some of the EHRs are kicking and screaming. They don’t want to share their data. Some of them just don’t have it together. Some doctors don’t put the data in the right fields for a standardized mechanism for data integration to be effective.  

What progress has been made with accountable care organizations?

Everybody says that’s the brass ring. That’s what we’re striving for. But I heard somebody from Intermountain say that it’s a 30-year journey. We are all working towards figuring out how to do accountable care.

CMS was a little stifled by the pandemic for a few years and the growth of ACOs didn’t occur 2020 through 2023. We are hoping that we are back on track. We see more and more patients being involved in some sort of accountable care relationship. That’s good. That’s what we want. We want somebody to be in charge of that patient’s health and to be looking at the whole patient. What we at Healthmonix are trying to do is to bring all that data together so they can see the picture of the whole patient.

Does having information available from multiple systems create new opportunities?

Yes, absolutely, and not just with EHRs. Social determinants look at where the patient lives. What sort of life does that patient have in terms of a support system? Are they in a food desert? Are they getting the sort of social support that they need? Then, combining that in. As we move forward, we’re integrating more and more sources of data so that when that patient walks into that care facility, a provider can get a much better picture of what is going on with that patient.

How do providers use the social determinants screening? Do any of the quality measures have it built in?

To get physicians started with using them, the Medicare programs, the ACOs, are giving providers bonuses for tracking those metrics. We call that pay for reporting. Then as we go forward, they are starting to factor those into measures. A lot of the measures are what we call risk based, where we take in social determinants or other patient history and give the provider credit for the fact that it’s a harder patient to take care of.

Is MIPS the only program that looks at these measures?

MIPS is a CMS program. It adjusts the payment that providers get from Medicare for fee-for-service. If you don’t participate in MIPS, you’ll get a 9% penalty on every single claim that you turn in to Medicare the following year. That’s a big hit. If you turn the data in that we compile — if we turn the data in for you, essentially — and you do well, then you can get up to a 2% to 5% incentive on every bill that you put into CMS next year.

CMS drives a lot of it, but there’s a whole rulemaking process that we participate in. We will draw up some of the quality measures that are in the MIPS and CMS programs, and then CMS will decide if they think it’s a good thing or not. Once CMS adopts it, it funnels out to private payers because there’s a certain standard of care that you want to adhere to for patients. A lot of what we do is based on science.

How does the cost analytics part of MIPS work?

MIPS decided that part of the score that you get from Medicare is based on this cost component. CMS is looking at how much is it costing to take care of your patients for certain episodes of care. When you have a knee surgery, what is it really costing CMS in terms of all the claims that come in for that knee surgery? That includes X-rays, anesthesiologist, the surgery if you’re in an ambulatory surgery center, the post-acute care that happens for 30 days afterwards, and complications. We look at that as a whole to say that the total cost of that knee surgery was X. We look at everybody across the US and figure out what the average was. If you did better than the average, then we say, yay, you’re doing great, and we give you an incentive. If you’re doing worse, then CMS will ding you for that.

What factors will be most important for the company over the next few years?

Data integration is a huge one. Can they really work to build better data interoperability? Because that will help a great deal. But I still think that we are going to need to spend a lot of time on data integration.

The other thing is that CMS is by far the leader in terms of where we’re going in terms of value-based care. Looking at the programs that they put forth, it will be interesting now with Mr. Trump to see how much he supports or does not support the movement into value-based care. I didn’t see a lot of changes in the four years of his prior administration, but there will probably be some changes in the next four years since he feels like he’s got a little bit more of a mandate. Those sorts of things will impact where we go with this.

Everybody’s favorite term right now is artificial intelligence. We report data for 50,000 providers across the US. To do these cost metrics, we gather a lot of claims data from CMS as well. We have a pretty big repository of healthcare data. Now we are digging into that data to understand the correlation between patients with great outcomes, both in terms of cost of care and in terms of quality, and all the other factors that are in there. We are trying to use AI to see if using this medication for this patient is associated with better outcomes. If you go to this kind of post-acute facility versus that kind of post-acute facility, does it impact the cost of care? I am hugely interested in exploring this as we go forward so that we can form this feedback loop with our providers to say, you’re doing really well here, and here are some areas where you can improve based on our analysis of data.

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Morning Headlines 11/13/24

November 12, 2024 Headlines Comments Off on Morning Headlines 11/13/24

$3 billion startup Sword Health cuts some physical therapists as it ramps up AI to treat more patients

Digital physical therapy services provider Sword Health reportedly lays off 13 physical therapists, about 17% of its clinicians, as it prepares for an IPO and follows through on plans to manage more patients using AI.

23andMe cuts 40% of its workforce and discontinues therapeutics division

23andMe will eliminate 200 roles and shutter its therapeutics division in an effort to restructure its business, which has seen declining revenue and plummeting shares over the last 12 months.

Quadrivia: Babylon founder Ali Parsa launches AI assistant for doctors, gets seed funding from Swedish VC Norrsken

Babylon founder Ali Parsa launches healthcare AI assistant company Quadrivia with seed funding from Norrsken.

Comments Off on Morning Headlines 11/13/24

News 11/13/24

November 12, 2024 News 1 Comment

Top News

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McKesson, Oracle, and NextGen Healthcare’s private equity owner Thoma Bravo are reportedly vying to acquire health IT, analytics, and data vendor Veradigm. A deal is expected to be reached by Thanksgiving.

Veradigm’s market valuation is $1.2 billion.


Reader Comments

From Swede: “Re: Oracle Health Millennium. Went live in Sweden for the first time, apparently without being registered with the Swedish equivalent of the FDA.” A Sweden-based publication says that Millennium doesn’t have a certificate from the Medical Products Agency, which is required for products that perform clinical calculations. Oracle has an option to CE-mark the product in another EU country, which would make the sale and use legal.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.


Acquisitions, Funding, Business, and Stock

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Drug distributor Cardinal Health will acquire a majority stake in national gastroenterology practice GI Alliance at a $3.9 billion valuation. GIA’s 900 affiliated physicians work in 345 locations in 20 states, which includes 135 ambulatory surgical centers, 165 hospital networks, and 95 infusion centers.

AI-focused digital physical therapy services provider Sword Health reportedly lays off 13 of its physical therapists, about 17% of its clinicians, as the $3 billion startup prepares for an IPO next year and follows through on plans to manage more patients using AI. Former employees say that the company is using AI to conduct patient conversations and to prioritize patients. Sword announced plans in September to land more employer customers by offering outcomes-based pricing.


Sales

  • In the UK, five NHS trusts go live on Agfa HealthCare’s image sharing network.
  • Augusta Health (VA) chooses Meditech Expanse.

People

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William Morris, MD, MBA (Google Cloud) joins Ambience Healthcare as chief medical officer.

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Nick Giannasi, PhD (Datavant) is named CEO of Aspirion.

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William Walders, MHA (BayCare Health System) joins The Joint Commission as VP/CDIO.

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Healthcare Integrated Technologies hires Caleb Dixon, MBA (Socket Health) as chief customer officer.


Announcements and Implementations

CarolinaEast Health System (NC) will go live on Epic on November 30.


Government and Politics

The VA announces plans to eliminate co-pays for telehealth services and to fund the deployment of telehealth kiosks in communities.

A Veterans Day announcement from Epic touts enhanced interoperability with the VA that allows Epic users to screen patients to determine their available VA benefits. Epic says the connection, which went live earlier this year at Tufts Medicine and Sanford Health, has identified 100,000 eligible veterans.

Rep. Vern Buchanan (R-FL), chairman of the US House Ways and Means Subcommittee on Health, asks CMS to encourage the use of digital health innovations in Medicare by changing the practice expense category of the Physician Fee Schedule.


Sponsor Updates

  • Wolters Kluwer Health publishes a new case study, “Sentri7 Drug Diversion boosts detection at large academic medical center.”
  • The Groupe santé CHC in Belgium selects Agfa HealthCare’s enterprise imaging for its medical imaging department.
  • The Slice of Healthcare Podcast features Arcadia CEO Michael Meucci.
  • Capital Rx releases a new episode of “The Astonishing Healthcare” podcast, “Pharmacy Benefits 101: DMP & MTM, Explained, with Nash Albadarin, PharmD.”
  • The “2024 KLAS Emerging Solutions Top 20” report features Care.ai’s Smart Care Facility Platform.
  • CliniComp celebrates its 41st anniversary.
  • Consensus Cloud Solutions will present and exhibit at the HIMSS Gulf Coast Conference November 14 in Mobile, AL.

Blog Posts


Contacts

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

Morning Headlines 11/12/24

November 11, 2024 Headlines Comments Off on Morning Headlines 11/12/24

VA proposes to eliminate copays for telehealth, expand access to telehealth for rural Veterans

The VA considers doing away with copays for all of its telehealth services and establishing a grant program to fund an expansion of its Accessing Telehealth through Local Area Stations programs, which serves veterans in rural areas.

Embargo Ransomware Gang Sets Deadline to Leak Hospital Data

The Embargo ransomware group threatens to publish data stolen from Memorial Hospital and Manor (GA) last week unless its ransom demands are met before November 12.

Astrana Health Announces Definitive Agreement to Acquire Certain Businesses and Assets of Prospect Health System

Provider enablement company Astrana Health will acquire Prospect Health’s hospital and medical groups, pharmacy, health plan, and managed services organization for $745 million.

Comments Off on Morning Headlines 11/12/24

Curbside Consult with Dr. Jayne 11/11/24

November 11, 2024 Dr. Jayne Comments Off on Curbside Consult with Dr. Jayne 11/11/24

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I’m always on the lookout for interesting research, and this recent article in JAMIA did not disappoint. The title was certainly eye-catching: “The number of patient scheduled hours resulting in a 40-hour work week by physician specialty and setting: a cross-sectional study using electronic health record event log data.” That’s a mouthful, but it calls attention to one of the pressing issues in ambulatory care today – packed physician schedules. It also alludes to the significant concerns around burnout and lack of work/life balance for clinicians, who are typically working longer hours than they want to.

A large amount of physician work occurs outside the confines of the office visit. These tasks include things like managing phone and patient portal messages, reviewing and managing laboratory and diagnostic testing results, collaborating with other members of the care team, crafting insurance appeals and compiling documentation for prior authorizations and referrals, completing documentation, and reviewing correspondence.

Efficient physicians who have strong support staff can often tackle many of these during patient care hours, i.e., they cram the tasks in between patients. Organizations that can afford scribes or ambient documentation solutions help physicians complete their visit notes before they leave the patient room, which frees up time that was formerly used for patient documentation that can now be used for all the other work.

Organizations that don’t prioritize that kind of support leave the physician to manage the rest of the burden themselves, which creates other issues. Physician burnout is one, which can lead to physicians leaving a practice for alleged greener pastures elsewhere, retiring early, or leaving medicine altogether.

Another issue is avoidance, where physicians are so overwhelmed they just don’t do the work, either leaving it to accumulate in their inboxes or just clicking through it without reading or addressing it. This approach creates patient safety issues. Some organizations have strong policies around it, but others wait until the levels of delinquent work reach ridiculous levels before taking action. Those actions are typically punitive rather than supportive, so one can guess at their level of effectiveness in making the physician want to behave differently in the future. 

The authors start with an introduction about the current state of clinical schedules versus physician time worked, noting that the average full-time US physician works 54 hours. More than 40% of us work more than 55 hours per week compared with 10% percent of workers in other fields. They also provide statistics on something that many of us have experienced first hand – that part-time work isn’t part time, with physicians who are working as 0.8 FTE (full-time equivalent) still averaging 46 hours per week.

The authors set about trying to answer this question — what is the appropriate number of scheduled patient care hours that would result in a 40-hour work week for physicians of various ambulatory specialties? They looked at 186,000 physicians from nearly 400 organizations and used data from November 2021 through April 2022.

I have to say that the timeframe caught my eye. We were still dealing with a substantial burden from COVID at that time, and also those months coincide with respiratory illness season, which disproportionately impacts some specialties. It made me wonder whether the results might look different if they looked at a larger time span that would help control for seasonal variation or one that was more typical and without the additional burden of COVID and its extra work notes, FMLA paperwork, and other administrative tasks.

The authors used EHR metadata to calculate a so-called PSH40 to depict the ideal number of patient scheduled hours that would result in the desired 40-hour work week, noting that the lowest numbers were in the specialties of infectious disease, geriatrics, and hematology. In my experience, patients who are seeing those specialists tend to have complex histories and challenging conditions, so I wasn’t surprised.

The highest numbers were in plastic surgery, pain medicine, and sports medicine. Those specialties had the lowest burden of work to be done outside scheduled patient hours, which the authors described as WOW (Work Outside of Work). Specialties that had fewer than 500 physicians in the sample were excluded, as were non-physician specialties such as dentistry, optometry, and podiatry.

The authors also looked at other practice characteristics, such as academic versus non-academic status, whether a practice was considered part of a safety net, and whether a specialty was considered primary care, a medical specialty, or a surgical specialty. Not surprisingly, academic, safety net, and non-surgical specialties all had lower PSH40 numbers due to their larger volume of WOW.

Although this concept of PSH40 is new, the authors state that, “We believe that health system leaders and physicians will benefit from data driven and transparent discussions about work hour expectations.” They note that current expectations “have been set by historical norms, are not based on objective data regarding the total work hours associated with a given number of PSH, have remained stable despite a growing volume of care outside of PSH through the patient portal and EHR inbox and are a source of uncertainty for organizational leaders and physicians.”

They call for future studies that look at different support staff structures and team care environments to see how the PSH40 might vary. They emphasize that work hours matter, with negative health outcomes associated with work overload. The fact that working more than 55 hours per week is linked to higher rates of heart disease and stroke was a new one for me.

The authors emphasize that physician burnout is linked not only to longer work hours, but also to lower patient satisfaction, lower quality and safety scores, higher rates of medical errors, and higher costs of care. These are all reasons that organizations should care about the data. Even if they don’t care about their physicians’ personal health risks, they definitely care about costs of care.

The authors note some limitations in the data used for the analysis, namely that it was from a single EHR platform (Epic) that has specific constraints about how it tracks physician activity. They recommend that organizations that want to use the PSH50 metric perform calibrations using local specialty-specific data from their own EHR.

The authors also note the limitation that EHR log data doesn’t capture non-EHR work such as phone calls and discussions in the office. Additionally, there would be complexity using the measure for specialties that also see patients in the inpatient environment or in ambulatory surgery centers.

Overall, I enjoyed reading this paper, which is not something I usually say when perusing academic publications. It’s an important topic and one that also impacts physician contracts and compensation.

An informal survey of some of my family medicine colleagues noted that their contracts required anywhere between 32 and 40 patient scheduled hours to be considered full time, with some agreements specifying a number of administrative time hours and others not mentioning that at all. This kind of measure gives institutions the power to monitor whether changes in processes are effective in reducing work outside of work and whether they have the potential to improve patient access.

Is your organization looking at a measure like this, or assessing work outside of work? Are things moving in the right direction to reduce burnout and improve patient care? Leave a comment or email me.

Email Dr. Jayne.

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Readers Write: Collaboration, Trust Remain Essential to Connecting the Last Mile for Healthcare Interoperability

November 11, 2024 Readers Write Comments Off on Readers Write: Collaboration, Trust Remain Essential to Connecting the Last Mile for Healthcare Interoperability

Collaboration, Trust Remain Essential to Connecting the Last Mile for Healthcare Interoperability
By Matt Koehler

Matt Koehler is vice president of product innovation for Surescripts.

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Successful collaboration in healthcare, while easier said than done, almost always results in meaningful improvements, such as better quality, safer, and less-costly care for patients. Collaboration is essential to innovation because it reinforces the trust that is needed between stakeholders. It’s especially critical when the safety and lives of patients are at stake. 

Stakeholder collaboration and industry input have been key in the development and implementation of the policy changes that are reflected in Common Agreement Version 2.0 that was released in July 2024 by the Assistant Secretary for Technology Policy / Office of the National Coordinator for Health Information Technology (ASTP/ONC) and The Sequoia Project or the Recognized Coordinating Entity (RCE). 

Beyond the technical aspects of this work, it’s worth emphasizing that ASTP/ONC and the RCE purposefully did not go it alone. They brought together the very healthcare technology stakeholders who would be directly impacted to weigh-in and develop the Standard Operating Procedures (SOPs) or the guidelines their organizations would ultimately be required to follow. They are the same guidelines that future healthcare technology innovations that are aimed at advancing interoperability would be built upon.  

The stakeholder-developed SOPs introduce new exchange purposes (XPs) to reflect the need to be more specific and intentional about why patient information is requested and exchanged. For example, TEFCA Required Treatment was introduced to clarify when Participants and Subparticipants must respond to a request. Additionally, three new Health Care Operations Level 2 XPs were introduced to require future exchange for Care Coordination/Case Management, HEDIS Reporting, and Quality Measure Reporting.

These changes provide a framework to illustrate the scenarios where future use cases will be required: 1) scenarios that fall under existing HIPAA definitions for use of healthcare information; and 2) have well-defined requirements for what data must be exchanged. The new XPs will be required in February 2026, marking an exciting evolution of information exchange. 

This new guidance is widely supported by industry experts who agree that it will deliver on its promise to advance interoperability, better enabling clinicians to provide safer, quality, and less-costly care for patients.

Another recent example of collaboration driving innovation is the Sequoia Project’s new Pharmacy Workgroup. As part of their Interoperability Matters program, this work looks to advance clinical interoperability for pharmacies. Specifically, to address barriers that they experience today related to the exchange of clinical data to provide clinical services by developing practical guidance to prepare and adopt these new standards. 

At a time when the challenges facing healthcare seem insurmountable, every example of cross-industry collaboration that led to a successful outcome, like developing the new SOPs, should be a hopeful reminder that together we can make meaningful progress towards improving care for patients and clinicians.   

We should remain committed to this work because of what it means for patients and the future of healthcare across the country: an exciting new framework for safe and effective interoperability with trust at the center of every new healthcare innovation. 

Comments Off on Readers Write: Collaboration, Trust Remain Essential to Connecting the Last Mile for Healthcare Interoperability

Morning Headlines 11/11/24

November 10, 2024 Headlines Comments Off on Morning Headlines 11/11/24

Doximity (DOCS) Tops Q2 Earnings and Revenue Estimates

Clinician network and drug marketing operator Doximity reports Q2 results: revenue up 20%, adjusted EPS $0.30 versus $0.22, beating expectations for both and sending DOCS shares up 34% in valuing the company at $11 billion.

McKesson, Oracle competing for Veradigm

McKesson, Oracle, and private equity firm Thoma Bravo are reportedly competing to acquire health IT, data, and analytics company Veradigm in a deal expected to close by Thanksgiving.

Waystar Reports Third Quarter 2024 Results

Waystar reports Q3 results: revenue up 22%, adjusted EPS $0.14 versus –$0.09, beating expectations for both.

Leidos awarded Organ Procurement and Transplantation Network operations contract

HHS awards Leidos a $235 million contract to modernize the country’s Organ Procurement and Transplant Network (OPTN).

Comments Off on Morning Headlines 11/11/24

Monday Morning Update 11/11/24

November 10, 2024 News 5 Comments

Top News

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Clinician network and drug marketing operator Doximity reports Q2 results: revenue up 20%, adjusted EPS $0.30 versus $0.22, beating expectations for both and sending DOCS shares up 34% in valuing the company at $11 billion.

The company said in the earnings call that its most profitable business is selling ads in its news feed,  while its fastest-growing offering is the AI-powered Doximity GPT workflow assistant, which processed 1 million prompts in Q2.


Reader Comments

From Anonymous: “Re: [vendor executive name omitted]. Removed from a plane intoxicated and arrested.” I’m not naming names per my longstanding policy of not calling out individuals who are involved in off-the-job arrests, lawsuits, or indiscretions. It’s news only if the company makes a statement to distance itself. For example, I wrote about a telehealth CEO who had a work-unrelated public altercation that I wouldn’t have mentioned except that his employer announced that he had been fired as a result, so that made it news. I am Golden Ruling it here — you yourself could get arrested for public intoxication, road rage, or a domestic issue, but I wouldn’t trash your reputation and maybe your career just because I have salacious details. Summon the oracle of Google if you need to know.

From Duopoly: “Re: Kaleida Health. I hear they are replacing Cerner with Epic.” Unverified, but they are listed on Epic’s UserWeb. Their open positions don’t have anything that is specific to Epic, but they have a ton of IT analyst openings. Kaleida spent $125 million to upgrade its Cerner system in early 2019.

From Griswold: “Re: Summa Health. A venture capital firm paying more than $1 billion to acquire a debt-laden, money-losing health system and turn it into a for-profit is one hella expensive technology test bed.” It will also be a public demonstration project for General Catalyst’s technology portfolio companies, which take a black eye if their products fail to improve Summa’s profit and quality. I don’t recall many (any?) cases where a health system gets better under the ownership of an investment firm that portrays itself as a money-indifferent white knight.


HIStalk Announcements and Requests

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Poll respondents say that Oracle’s biggest challenge with its new EHR will be getting former Cerner customers to switch to that system instead of Epic. I signed up for an Oracle Health webinar next week that will provide a sneak peek.

New poll to your right or here: Which city or region has the strongest claim for being the US capital for health tech? How times have changed with the former obvious answers of Malvern and Kansas City don’t make the list and Atlanta is a long shot.

A handful of HIStalk sponsors have left the fold because they were acquired, ran short of money, changed strategy, or lost the only employee who knew anything about their sponsorship. Contact Lorre to replace them, especially if they were your competitor. She will offer some spiffs if you’re a startup or maybe if you are a former sponsor.

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I used the image analysis capability of the ChatGPT phone app twice yesterday. I was looking for an unusual, inexpensive wine to serve to a neighbor who is coming over for dinner, so I took pictures of each label that I was considering and asked ChatGPT to tell me about each wine’s quality and whether it would go with what we were serving. Later that day, Mrs. H mentioned wanting to preserve old family recipes that have been handed down to her over the years, so I took a photo of each and had ChatGPT convert the barely readable cursive handwriting into text that I could copy-paste into Word (pro tip: the best recipes have the most smudges). I bet it would have excelled at interpreting old-school handwritten prescriptions.

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Thanks to veterans – no matter when, where, or how you served – on Veterans Day. Sunday was the 249th birthday of the US Marine Corps, so thanks to those who always run toward the sounds of chaos.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.


Acquisitions, Funding, Business, and Stock

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Health Catalyst reports Q3 results: revenue up 3%, adjusted EPS $0.07 versus $0.03, meeting revenue expectations but falling short on earnings. HCAT shares are up 37% in the past 12 months, valuing the company at $501 million.

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TruBridge reports Q3 results: revenue down 1%, adjusted EPS –$0.21 versus $0.45, beating revenue expectations but falling short on earnings. TBRG shares are down 3% in the past 12 months, valuing the company at $203 million. COO David Dye, who has been with the company for 34 years, will retire at the end of the year.

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Waystar reports Q3 results: revenue up 22%, adjusted EPS $0.14 versus –$0.09, beating expectations for both. WAY shares are up 51% since the company’s IPO on June 7, 2024, valuing the company at $5.4 billion.

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Evolent Health reports Q3 results: revenue up 22%, EPS $0.04 versus $0.30, falling short on expectations for both and send shares down 46% in valuing the technology-focused care management company at $1.5 billion. The company blames higher-than-expected medical costs that will require it to renegotiate or exit some of its risk-based contracts with payers.


People

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Optimum Healthcare IT promotes Dan Robinson to VP of client services.


Government and Politics

HHS awards Leidos a $235 million contract to modernize the country’s Organ Procurement and Transplant Network (OPTN). The system has been operated since 1986 by the United Network for Organ Sharing (UNOS) and has generated more than 1,000 complaints and accusations of a monopoly.


Privacy and Security

Former organ donation organization employee Trent Russell is sentenced to two years in prison for accessing and screen-shotting the EHR data of then-Supreme Court Justice Ruth Bader Ginsburg, whose hospital chart then showed up on 4chan conspiracy theory message board. The prosecutor said that Russell “offered completely implausible excuses with a straight face,” referring to the defendant’s insistence that his cat must have run across his keyboard.


Other

FDA Commissioner Rob Califf, MD urges clinicians to help their patients understand medical misinformation, adding that AI may help by giving them more time for such discussions during encounters.


Sponsor Updates

  • Inovalon announces that customers who are using its Converged Quality healthcare quality data analysis and improvement software realized a 5% increase above the national average of 2025 Medicare Advantage Star Ratings.
  • WellSky partners with the National Association of State Directors of Developmental Disabilities Services to publish survey results on how state directors plan to comply with the CMS “Ensuring Access to Medicaid Services” rule.
  • CereCore releases a new podcast, “Happy Doctors and Technology: A CMIO and Practicing Physician’s POV.”
  • RLDatix publishes a new resource, “AdventHealth Reduced Falls by 80% With Scalable, Data-Driven Bootcamp.”
  • SmartSense by Digi will exhibit at the ASHP 2024 Midyear Clinical Meeting & Exhibition December 8-12 in New Orleans.
  • A new study by WellSky Foundation and Meals on Wheels America reveals meal delivery services significantly reduce senior hospitalizations.
  • Clinical Architecture, InterSystems, Wolters Kluwer Health, and Elsevier will sponsor and/or exhibit at AMIA 2024 November 9-13 in San Francisco.

Blog Posts


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