News 6/29/18

Top News

Amazon will acquire online pharmacy PillPack, which dispenses patient prescriptions as individual time-sorted doses. The company is also known for its sophisticated technology, which includes patient apps and order processing systems.

Shares of CVS and Walgreens dropped sharply on the news that Amazon has made its long-rumored healthcare entry.

I wrote about PillPack in mid-2015, amused by the physical description of its pharmacist founder as, “the guy you might buy pot from at a Dead concert.” He also offered his reaction to its just-raised $50 million, “We should probably hire a finance guy.”

Amazon’s acquisition price wasn’t disclosed (rumor: $1 billion in cash), but PillPack had raised $122 million through its Series D round in September 2016. The company said last year that it expected to bring in $100 million in revenue for 2017. Walmart was rumored to have been close to buying the company in April 2018 for under $1 billion, but didn’t pull the trigger fast enough.

The founders, who are both around 30 years old, met through MIT’s Hacking Medicine.

As someone noted on Twitter, you can now buy everything Walgreens sells through its drugstore from Amazon. Amazon could also connect with insurers who want an alternative to giving business to pharmacy benefits manager Express Scripts, which Cigna acquired for $67 billion a few weeks back. That would take some work since to my knowledge, PillPack offers just the prescription-filling service and doesn’t negotiate manufacturer prices or manage the use of specialty medications.

Still, Amazon has the clout to turn the company into a PBM given that it now has the necessary pharmacy licenses (49 of 50 states, excluding Hawaii), multiple fulfillment locations, and the technology needed to scale.

HIStalk Announcements and Requests

Maybe it’s unreasonable to expect an India-based research firm that covers everything from strollers to glass tableware to understand healthcare intricacies, but one might ponder the wisdom of spending $3,300 for a report that in every instance refers to “HER” instead of “EHR.” I generously offer this free advice: in Word, click File, Options, Proofing, AutoCorrect Options, and then remove the entry that corrects “ehr” to “her.” Svaagat hai.

Thank you, The Atlantic, for noting “exclamation-point inflation” in which two or more exclamation points are now required to properly indicate written enthusiasm. The article notes the precedent of diluting the value of “awesome” as overused term in an attempt to overcome the non-signaling blandness of email conversation. I’ve seen Facebook posts that (a) ended every phrase with one or more exclamation points like the writer was on their eighth cappuccino of the morning; (b) ran a single sentence for hundreds of words with seemingly random blurting separated only by ellipses; and (c) use those annoying text-as-a-picture things whose point I clearly don’t understand since I find them nearly as aggravating as running movie clips turned into GIFs to indicate one’s reaction on Twitter.

Webinars

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

Acquisitions, Funding, Business, and Stock

Medical procedure shopping app and “on-demand insurance” vendor Bind raises $10 million from investors that include Ascension Ventures and UnitedHealth Group, increasing its total to $70 million. The company offers basic medical benefits from insurers and then allows employees of it customers to shop for procedures by price, where they pay co-pays but no deductibles. The founder and CEO is Tony Miller, a former health benefits company CEO who is a managing partner of healthcare services venture capital firm Lemhi Ventures, whose other active investments include PokitDok and Recondo. 

Here’s what market power allows you to do – ATT increases its easily overlooked “administrative fee” cell phone bill line item from $0.76 to $1.99 (I’m paying $1.26, from my bill above), which sounds innocent enough until you do the math and realize the company will get a free $800 million per year to help pay for its $85 billion acquisition of Time Warner. Because it can.

Cerner settles a class action lawsuit brought by employees who say they weren’t paid overtime, but details may not be released since Cerner has asked the court to seal the agreement’s details (legal sources place the figure at $4.5 million). The company denies wrongdoing but says the settlement is in its best interest as long as the details aren’t made public. The lawsuit was filed on behalf of delivery consultants and system analysts by a former employee who says those are entry-level jobs that require no background in systems analysis, software engineering, or programming. 

Sales

• LabCorp will deploy the Phillips IntelliSite digital pathology system for reducing diagnostic time and for collaborating with specialty pathologists.
• Jackson Health System (FL) signs an 11-year agreement with Philips for enterprise patient monitoring for a per-patient fee.

People

Healthwise promotes chief medical officer Adam Husney, MD to president.

The Johns Hopkins School of Nursing hires Kenneth Dion, PhD, RN, MSN, MBA to the newly created position of assistant dean for business development and strategic relationships. His work history includes the founding of Decision Critical and incubator TurnPath as well as time spent as a VP of HealthStream.

T-System promotes Robert Hitchcock, MD to EVP and GM of documentation.

Harvard Medical School professor and EHR pioneer Warner Slack, MD has died at 85. He floated the idea in the mid-1960s that computers could be used to “help patients to help themselves with their medical problems” extending his belief that “patients are the most under-utilized resource in healthcare.” Slack was a UW-Madison medical resident in 1965 when he proposed that computers could interview patients to give their doctor better information for their treatment. He was co-chief of BIDMC’s Division of Clinical Computing, which created early hospital computer systems. He wrote a 2001 book titled “Cybermedicine: How Computing Empowers Doctors and Patients for Better Care.”

Announcements and Implementations

Meditech customer Alliance Community Hospital (OH) goes live on CommonWell’s interoperability services. I was about to write “FHIR-powered services,” which made me realize my own suppressed marketing potential as I then contemplated trademarking the term “FHIRpower” to cash in on the lowbrow punning by those who are endlessly amused that “FHIR” can be questionably contrived to sound like “fire” if you fancy yourself a health IT wit.

The endlessly-hyped HLTH conference will move its planned second iteration from May 2019 to October 2019. Somehow the founders – who raised a fortune in VC money – failed to notice that the HIMSS conference owns the springtime conference schedule (duh) and the idea of holding theirs immediately afterward in the same city (Las Vegas) was kind of stupid. Investors now have to wait an extra five months before the company’s next revenue bolus, assuming it really does rebound from its amateurish error for a late 2019 redux. It will probably be fine since many in our industry never met a conference they didn’t like attending, raising the question of how valuable they are to employers that chug along fine without them.

Verily (the former Google Life Sciences) will provide digital health technology for an insulin patch pump for diabetics that it will commercialize with drug maker Sanofi and micro-pump technology vendor Sensile Medical.  

Government and Politics

Congressman Phil Roe, MD (R-TN) says in a Tuesday VA EHR hearing, “It’s incredibly important that these health information exchanges work, that we can share information. It’s a problem in the private sector, trust me. You can’t go to a hospital and get the information .. One of the things that bothered me when I was out at Fairchild was that on MHS Genesis, when you came in, what was entered into the EHR was basically allergies, medications, medications, procedures. I can get that in one minute of asking somebody. Other data, what I really want to see, are your lab results, x-ray reports, notes from previous visits, discharge summaries. You have to use the Joint Legacy Viewer to look back. That slows you down … are we going to be able to put all this information in … without using two systems? If we do, what’s the point of using Cerner?” Roe also noted that the VA’s needs are different from DoD’s since active military members are mostly young and healthy. The VA responded that Cerner will ingest all records, including those from community providers.

Also from the VA hearing: Congressman Tim Walz (D-MN) noted that VA Acting CIO Camilo Sandoval wasn’t invited: “At the heart of the single biggest electronic project maybe we’ve ever done in government, we haven’t received one phone call, one text, or one interaction at all with Mr. Sandova,l” but the VA’ers in attendance assured him that project governance structures and GAO oversight is being developed, to which Walz reminded the committee that the VA does not have a confirmed secretary, deputy secretary, undersecretary for health, or CIO. The VA also acknowledged that the project will require up to $6 billion for infrastructure and project management on top of the $10 billion that will be paid to Cerner. Cerner President Zane Burke (misidentified as CEO by as least one site) told the committee that ongoing costs will be less than with VistA. Burke stammered a tortured response (as a reader noted) when he was zinged by Congressman Bruce Polquin (R-ME) with the question of whether DoD is on time and on budget with its own Cerner implementation: “They’re on… to date that that there were on that’s I … we’ve think we’ll be ah … we’ll be a stay on time and on budget as it relates to that … in the … in that perspective.”

The Department of Justice charges 601 defendants — including 165 doctors, nurses, and other licensed professionals – for $2 billion in fraudulent billings for medically unnecessary or compounded prescriptions. Among the details of the largest health fraud takedown in history: 84 of of the cases involve the illegal distribution of 13 million doses of opioids; claims for hundreds of millions of dollars were filed for phony substance abuse treatment services; a compounding pharmacy provided prostitutes and dinners to podiatrists who issued prescriptions on pre-printed forms that generated $250 million in fraudulent pharmacy claims; doctors were charged for taking kickbacks from home health agencies; and a medical transportation company that cruised the street for people willing to take cash for fraudulent physical and occupational therapy took in $7 million.

Zuckerberg San Francisco General Hospital examines a South Korean tourist’s baby who had fallen off a hotel room bed, determining that the child was fine and required no treatment. Two years later, the family receives a bill for $19,000, $16,000 of which involved “trauma activation” fees, in which any trauma center can make up an activation fee even for cases in which no trauma services were actually delivered. Another patient seen for a broken ankle was hit for the same $16,000 trauma response fee, which with other charges insurance wouldn’t cover, left her with a bill for $31,000. Another patient seen by a California hospital for a minor motorcycle accident was sent home after receiving no diagnostic tests and treatments that included only an IV, ibuprofen, and staples, leaving him with a $27,000 bill, of which $23,000 was a trauma response fee. Because they can.

Other

In Australia, the federal government announces that a three-member panel will spend the next five months reviewing the paused rollout of South Australia’s Allscripts-powered Enterprise Patient Administration System, which the health minister describes as an “enormous frustration for many clinicians and a rolling disaster for South Australian taxpayers.” Project costs are running double the 2013 estimate of $162 million as doctors criticized the system as “unfit for purpose” and “dangerous.”

Diagnosis chatbot vendor Babylon Health, which powers NHS’s GP at Hand app, claims that its AI-powered bot scores as well as human doctors on medical exams, although doctors are skeptical since they can’t verify the company’s claims and they say patient will still end up seeing a doctor. The company says it will roll the system out as an Alexa skill.

Some lawyer’s family is now financially set for at least three generations: a California county and its tree inspection contractor will pay $47.5 million to settle the case of a seriously injured 12-year-old public park camper whose tent was crushed by a falling tree.

In the UK, a drug-abusing anesthesiologist who was previously accused of looking up celebrity medical records and injecting himself with leftover patient opiates dies on the last day of his honeymoon after taking medications he bought on the dark web.

Sponsor Updates

• Patientco adds patient financing solutions from Curae to its SmartFinance platform.
• Mobile Heartbeat and Amplion Clinical Communications will integrate their respective enterprise mobility and nurse call systems.
• PatientKeeper publishes a new ebook, “Attending to Physicians: Why Healthcare Must Focus on Improving Physician Experience.”
• James Welsh joins Mazars USA’s Pennsylvania office practice as partner.
• The Chartis Group publishes a white paper titled “The Disruption of Primary Care: How Customer-Obsessed Companies are Changing Everything”

Blog Posts

• How Healthcare Mergers and Acquisitions Affect EHR Interoperability (Definitive Healthcare)
• Healthcare CIOs: 5 Easy Ways to Keep Weeds Out of Your Projects (The HCI Group)
• A Social Forum: Meditech gathers nurses for open dialogue opportunity (Meditech)
• Good News: Summer’s Here! Better News: School is Still in Session (Navicure/Waystar)
• Shaping Home Health and Hospice Through Advocacy (Netsmart)
• How the EHR could help stem the opioid epidemic (Nordic)
• How Duke Private Diagnostic Clinic ensures efficient reimbursement (Experian Health)
• Health System Mergers: Why Hospitals Won’t Stop Merging (The SSI Group)
• Now is the time to replace your pagers. (Voalte)
• Up and Leave: What to do When a Therapist Quits (WebPT)

Contacts

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

EPtalk by Dr. Jayne 6/28/18

Amazon is leaping into the world of healthcare with its acquisition of PillPack online pharmacy. This should have retailers and drug suppliers looking closely at their business models. Investors are already questioning the impact, with Walgreens and CVS shares each dropping 8 percent.

Amazon is paying $1B for the Boston-based company, expected to close in the second half of the calendar year. Retail prescriptions are a $300B business in the US, with CVS and Walgreens having large pieces of the pie. PillPack is licensed to deliver mail-order pharmacy services in all 50 states and also has connections to pharmacy benefit managers such as Express Scripts and CVS. It provides pre-packaged drugs to patients and automates tasks involved in the prescription refill process.

I put my physician hat on to think about its potential impact to the industry, and one concern is patient safety. With the different packaging, patients on complex medical regimens may need to change how they handle their meds and will want to watch carefully if they are transferring pills to home tracking boxes. Physicians will need to be aware of this new supplier and whether specific orders are needed for medications, for example the often-added instruction to put meds in an easy-open container or to label in a foreign language. Still, competition is generally good in most industries, so we’ll see where this goes.

I work with a number of clients that need help in translating their vendors’ communications about clinical quality measures into instructions that their internal teams can follow. The content and readability from different vendors varies, and there are definitely some superstars out there who hand-hold their clients through the entire process. There are also companies that provide vague instructions and don’t even include workflows, leaving clients to guess at where the need to document certain data elements.

There’s always some uncertainty with CQMs early in the calendar year, as vendors are responding to federal and other requirements that may be issued or modified in October, November, or December with the expectation that they be fully built and available in EHRs and quality management tools on January 1. That’s a tall order to fill for many vendors, and clients are typically twitchy, so I’m going to offer some free consulting advice. If your vendor hasn’t shipped the measures yet and you can’t run reports, you can still launch quality improvement projects to your organization. Create awareness, deliver training, and make sure your users understand and incorporate any workflow changes. Then, you’re already down the change management pathway, and when reports become available, you’re ready to go for continuous improvement. I see a lot of clients that try to use the lag between January 1 and the vendor’s delivery of reports as an excuse for not doing their part.

I write a lot about the physician space and what providers are thinking, but I had a chance to meet up with one of my friends who is on a major vendor’s implementation team. He always has good stories and our catch-up over cocktails did not disappoint. Early in my informatics career, I had to serve as a part-time implementation person because our hospital didn’t see the need to pay for a full-time clinician to do clinical informatics. I deployed small practices, doing everything from project management to re-routing cables under desks so we could streamline the check-in area. I was yelled at by physicians for no reason (other than they were angry about even having to think about touching a computer) and made friends with office managers who hoped that I could be a “physician whisperer” and get difficult providers in line. It gave me a new respect for the team that does implementations full time and the challenges they face.

My friend just worked with a practice that was recently acquired by a hospital system. Apparently his managing partners were much more keen on the alliance than he was, so he spent the first hour of their training time railing on the decision to join the hospital and his need for autonomy and to be able to do things the way he thinks is best for his practice and his patients. The hospital is enabling physician autonomy by providing then the option to simply dictate notes using voice recognition technology or to use scribes, as an alternative to template-driven documentation.

However, when the first patient of the day came in with a chief complaint of “my mother-in-law says I have dark circles under my eyes,” he demanded to know which template he should use in the system to complete the note, refusing to dictate the note on this uncommon reason for a physician visit, and stating that if he was going to have to use the system, it better be able to support him. I don’t know what to tell people about that situation other than to chalk it up to an end user who is reactive and illogical due to the stresses he is under. All we can do with people like that is to try to support them, try to show them different ways to document, and to hope they understand that the EHR is not going away.

He also shared the story of an “emergency go-live” that he was summoned to recently. Apparently a large provider network was adding an incremental physician in a new office and forgot to arrange for provider training and go-live support (the staff was being moved from other locations and already had knowledge of the system.) I sympathized with his road warrior tales as he tried to book a ticket with a few days notice and the client was refusing to approve it due to the high cost, leading to an impasse with the client and a delay in the go-live to when the ticket was more affordable. Clearly having a contracted physician idle in the office was a better ROI than buying the ticket.

He also does a fair amount of support for his company’s sales team and had a good story about a lead for a 200-doctor group that came in three days prior to the end of the quarter, but which his sales team actually thought they could close before the deadline. Of course it’s possible if the practice doesn’t want to ensure stakeholder buy-in or doesn’t want to fully understand what they’re getting into. At this point in the healthcare IT game, neither would surprise me.

What’s the wildest last-minute project you’ve seen? Email me.

Email Dr. Jayne.

Morning Headlines 6/28/18

Molina Healthcare Reaches Agreement with DXC Technology to Sell Medicaid Management Information Systems Business

Molina Healthcare will sell its Medicaid Solutions IS business to DXC Technology for $220 million.

‘Failure is not an option’: VA nominee Robert Wilkie told to fix the agency’s morale crisis

Members of the Veterans’ Affairs Committee tell VA Secretary nominee Robert Wilkie during his Senate confirmation hearing that the agency is in desperate need of leadership after the tabloid-like ouster of former Secretary David Shulkin, MD and nominee Ronny Jackson, MD.

Tampa Bay tech community pulls together to help displaced CareSync workers

Tampa, FL-based tech companies and associations are quick to publicize job openings and host job fairs in the wake of CareSync’s abrupt closure.

VA will have 3 Cerner-powered hospitals by 2020

Acting VA Secretary Peter O’Rourke tells lawmakers that the VA will begin deploying Cerner software at three hospitals this October, with full implementation expected by 2020.

Morning Headlines 6/27/18

GE Focuses Portfolio for Growth and Shareholder Value Creation

GE will spin off GE Healthcare into a standalone business as the struggling behemoth that yearns to be a “simpler, stronger GE” focuses on its aviation, power, and generator businesses.

New team assembled to unlock the innovation potential in healthcare data

Microsoft Healthcare hires Jim Weinstein, DO, MS (Dartmouth-Hitchcock) as head of innovation and health equity and Joshua Mandel, MD (Verily) as chief architect.

VA IT MODERNIZATION Preparations for Transitioning to a New Electronic Health Record System Are Ongoing

A GAO report finds that the VA was spending $1 billion per year maintaining VistA, and that work remains to define exactly what VistA is and how Cerner can replace the nearly 50 percent of VistA applications that don’t have a Cerner counterpart.

Greenway Health Announces Richard Atkin as the Company’s New CEO

Richard Atkin (Vista Equity Partners) replaces Scott Zimmerman as CEO of Greenway Health.

News 6/27/18

Top News

GE will spin off its GE Healthcare into a standalone business as the struggling behemoth that yearns to be a “simpler, stronger GE” focuses on its aviation, power, and generator businesses.

GE Chairman and CEO John Flannery said in a statement, “GE Healthcare and BHGE [the former Baker Hughes oil field division] are excellent examples of GE at its best—anticipating customer needs, breaking barriers through innovation, and delivering life-changing products and services. Today’s actions unlock both a pure-play healthcare company and a tier-one oil and gas servicing and equipment player. We are confident that positioning GE Healthcare and BHGE outside of GE’s current structure is best not only for GE and its owners, but also for these businesses, which will strengthen their market-leading positions and enhance their ability to invest for the future, while carrying the spirit of GE forward.”

GE Healthcare President and CEO Kieran Murphy will continue his role with the standalone company, which brought $19 billion in 2017 revenue before its jubilant unlocking.

Reader Comments

From Sullen VIsage: “Re: Athenahealth. This poll says they should not sell out to Elliott Management.” I wouldn’t assign much value to an online poll whose results are headlined without indicating how many people voted (that site’s past polls have had a pitiful turnout), but there’s also the bias of customers and employees to resist change. Publicly traded companies, however, have just one customer – their investors — and the company is obligated to take whatever course of action that maximally enrichens them. The real question is whether that enrichment might be woefully short term versus the longer-term value that could be wrung out by keeping customers happy, improving efficiency, and allow their strategies the time to mature. However, corporate raiders are more interested in yard saling the assets and moving on to the next company rather than building value, while investors aren’t opposed of the idea of banking a quick profit by selling off the body parts.

From Pomposity: “Re: CareSync. Clueless management strikes again and leaves employees hanging.” Maybe, but we don’t know why the company suddenly closed its doors. The timing suggests a due diligence issue that was performed late in the process, plus we already know from the “ran out of time” comments that the company was desperate to mate with a sugar daddy. You have to stop the bleeding at some point. It is hard to fathom, however, how a company could raise nearly $50 million, hire a ton of people and move them into a swanky headquarters, operate in what seems like a promising business sector, and then blow up whatever asset value and goodwill remained by just turning off the lights for good. I can only speculate that despite the investment interest, the company was burdened with so much debt that even bankruptcy couldn’t have saved it. It’s also hard to fathom why CareSync needed 300 employees to run what seems like a simple, modestly promising business, but I can’t second guess the folks in charge since their money was on the line and mine wasn’t.

Webinars

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

Acquisitions, Funding, Business, and Stock

Clinical interoperability network vendor Health Gorilla raises $8.2 million in a Series A funding round.

Outcome Health co-founders Rishi Shah and Shradha Agarwal – who had already resigned their top executive positions in a settlement with investors who claimed the company had defrauded them – leave their board positions as the company tries to regain credibility and its pre-scandal $5 billion valuation.  

Sales

• AllianceRx Walgreens Prime —  the specialty pharmacy formed by Walgreens and pharmacy benefits manager Prime Therapeutics – chooses Inovalon’s specialty pharmacy system.
• Amita Health selects R1 RCM for revenue cycle management services.
• Memorial Healthcare (MI) selects Parallon Technology Solutions to lead its conversion from Meditech’s Magic to Expanse.
• West Virginia’s pharmacy board will use Appriss Health’s PMP Gateway to give all state prescribers and pharmacists workflow access to the company’s NarxCare system for detection of opioid misuse.

People

Microsoft Healthcare hires Jim Weinstein, DO, MS (Dartmouth-Hitchcock) as head of innovation and health equity and Joshua Mandel, MD (Verily) as chief architect.

Announcements and Implementations

Change Healthcare releases Assurance Attach Assist, which reduces provider claims rejection by recognizing the documentation that payers require and providing an electronic platform for its submission and management.

Government and Politics

A GAO report finds that the VA was spending $1 billion per year maintaining VistA, but even as it plans that system’s replacement with Cerner, work remains to define exactly what VistA is – especially regarding its site-specific customization – and how Cerner can replace the nearly 50 percent of VistA applications that don’t have a Cerner counterpart.

The American Hospital Association tells CMS that it “strongly opposes” making interoperability a requirement of Medicare participation, noting these problems:

• Not all providers who would be potential exchange partners use EHRs
• The information exchanged might not be useful
• The required workflow is cumbersome
• Lack of a single patient identifier hinders accurate exchange
• Information exchange across different EHRs is hard
• Metrics for measuring interoperability are lacking

Other

Oklahoma State University will name its nearly-completed, $20 million women’s soccer stadium after alumnus, major benefactor, and former Cerner Chairman and CEO Neal Patterson, who died a year ago.

A Bloomberg analysis finds that government-encouraged employer experimentation with high-deductible health plans in the 1990s has made them nearly universal, with the result being that cash-strapped patients have simply stopped getting medical care instead of shopping for healthcare value as politicians had predicted. The plans have saved employers money, but in ways that seem to have harmed the long-term health of their employees in ways that may eventually become the problem of taxpayers who fund Medicare and Medicaid. A Comcast executive says, “Why did we design a health plan that has the ability to deliver a $1,000 surprise to employees? That’s kind of stupid.” He didn’t mention the people who buy their own insurance on the individual market who will be likely sucked in by the lower premiums of junk policies such as association health plans, whose nearly indecipherable terms exclude basically anything that requires a significant payment, such as those involving pre-existing conditions. As a restaurant guy told me once, you can buy hamburger meat at nearly any price you want to pay, but that doesn’t mean you would want to eat it.

A TransUnion Healthcare study finds that an average hospital stay sticks the patient with a $781 bill after their insurance has paid, a 67 percent increase in the past five years.

In Japan, two people with cancer die untreated after hospital radiology departments fail to share their diagnostic images with other departments within the same hospital , while several other patients required more complex surgeries due to treatment delays. An expert says information sharing has become more complicated as increasingly sophisticated medical equipment has increased data volume.

Interesting: the Kansas City paper describes a county IT guy’s experimentation with a cheap antenna to allow his laptop to pick up TV stations, during which he started intercepting unencrypted hospital pager messages that included names, demographics, and diagnoses. The paper contacted one of the patients whose name appeared in the message, to which she offered her succinct reaction: “What the hell?”

Sponsor Updates

• HCTec will host the HIMSS Tennessee new member reception June 28 in Brentwood.
• Hyland completes a 70,000 square-foot expansion at its headquarters in Westlake, OH.
• News: Hyland’s OnBase 18 release focuses on building better user experiences, expanding security
• InterSystems produces a new video, “Providing the VA with Interoperable Solutions Matters.”
• Hyland releases Version 18 of OnBase.
• Summit Healthcare announces that several customers have upgraded from its Express Connect to Summit Exchange Platform.

Blog Posts

• Dying, A Choice of Quality (HBI Solutions)
• Meditech’s Nurse and Home Care Forum Brings Clinical, Personal Perspective (Meditech)
• Timely Filing: Optimizing Revenue Cycle Team Performance (Impact Advisors)
• #TBT Innovations from the National Conference (EClinicalWorks)
• Dying, a Choice of Quality (HBI Solutions)
• Back to Basics: Wi-Fi Coverage Is Key to Secure Messaging Success (Spok)
• Healthcare CIOs: 5 Easy Ways to Keep Weeds Out of Your Projects (The HCI Group)
• Prepare for battle: We’re heading into a downtime! (Hyland)
• Scottsdale Institute Roundtable Shares CEO & CIO Top IT-Related Priorities (Impact Advisors)
• The clinician’s important role in IT decision making (Imprivata)
• Healthcare CRM for Behavioral Change (Influence Health)

Contacts

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

Morning Headlines 6/26/18

Outcome Health founders step down from board

After cutting its staff headcount by half and bringing on a new CEO, Outcome Health founders Rishi Shah and Shradha Agarwal step down from the board in an effort to “provide clear leadership transition for the new management team.”

Netgain Acquires iManaged Solutions to Expand "Specialized IT Cloud" Expertise

Healthcare cloud services company NetGain Technology acquires IManaged Solutions for an undisclosed sum.

State switches to electronic health records for prisons

Prisons in Connecticut will move from paper to GE Centricity medical record software.

Chief Health Informatics Officer

CMS looks to hire a chief health informatics officer who will develop health IT and information management strategy for CMS and HHS.

Curbside Consult with Dr. Jayne 6/25/18

I’m gritting my teeth after the recent CareSync debacle, especially as it comes hot on the heels of so many other closings, layoffs, restructuring, and “right sizing” maneuvers across the industry. I realize that CareSync, like so many other companies that find themselves at the end of the line, was a start-up, but that doesn’t make its closure any more palatable for its customers or its employees. One of my clients had done business with them, and although the integration with the product moved at a snail’s pace, they seemed to be on the up-and-up and eventually did deliver what was promised.

When billing for Medicare Chronic Care Management services, there are specific rules that must be followed in order for the billings to be valid. For primary care practices caught in the “chicken or egg” phenomenon, where you have to collect more money to hire care coordinators to perform care management to make more money, a vendor like CareSync seemed like it was sent from above. They were willing to take on the care management functions for a share of the Medicare reimbursement, allowing the practice to provide the services without having to increase head count.

I know there were some bumps at the beginning, where patients in the practice were less-than-willing to talk to perceived “outsiders” who had access to their medical information. However, I had heard that after a while, CareSync had begun to virtually embed care coordinators within particular practices, so that patients became familiar with the personnel and it seemed less like an outsource function. I only had a couple of connections with them through my clients, and don’t know a lot of the details, but I can imagine the practices are wringing their hands about what to do next and how to get their data, even though CareSync is assuring everyone that the data will remain accessible. It’s not clear for how long it will remain that way, and the one practice I reached out to hasn’t heard anything from the company (not surprising, given the way it shuttered itself).

It’s surprising that the sale that was supposed to save it unraveled so quickly, with the potential buyer visiting with employees on Monday and the company closing down on Thursday. When things fall through in deals like this, you usually see the wheels come off during the due diligence phase or during the negotiations, not while the bride and groom are at the altar but just haven’t signed the wedding license yet. There have been comments about the company “running out of time,” but what exactly that means just isn’t clear.

In any of these layoff or closure situations, my first thought is with the people who were just let go. This case is particularly bad because the company has simply closed, with no severance packages offered, no provisions for insurance coverage under COBRA, and possibly not even a last paycheck or settling of other benefits such as flexible spending accounts. For people higher in the company who fully understood what it means to be part of a start-up, they are likely prepared for such a scenario. For lower-wage workers on the front lines, especially for those living paycheck to paycheck in a relatively tough economy, it’s devastating. According to surveys, as many as three quarters of full-time workers fall into that category. A full 40 percent of us can’t cover a $400 emergency expense, and it’s especially challenging for workers who are paying off student loans or have other challenging circumstances.

I have several good friends who have entered the ranks of the jobless this year, from three different companies and from different segments of healthcare IT. Most are in their mid-to-late 40s, but one is in his late 50s and has some family issues that make working a traditional nine-to-five job challenging. The odds of him finding a new full-time position with an employer willing to allow him to work flex time right out of the gate are very slim, especially in his part of the country. It’s hard to know what to say to a friend who has just lost his job, especially when you work together and you know it might be you the next time. There is a certain level of survivor’s guilt while you’re still trying to understand what you can do to be helpful. My friend said the hardest thing for him was having people tell him things like, “Now you can spend more time with your family member who needs you,” when they don’t understand that without income, a very delicate stack of spinning plates is going to crash down on them. Sometimes it’s better to just say, “I’m sorry, how can I help?”

I have another friend who now refers to herself as a “layoff magnet” since she has been “made available to the workforce” three times in the last five years. It’s not like she’s picking sketchy employers, but has been with several big players in the EHR space, only to have her project canceled, her division sold off, or her entire team downsized. She’s not even sure she wants to continue in the healthcare space, which really is a loss to the industry, but I don’t blame her. Other friends have gone to the automotive industry or financial sectors, with at least theoretically more stability. Another one got his real estate license, and although isn’t making as much money as he did in healthcare, feels like he has better quality of life. One is teaching middle school. I think he’s the gutsiest of them all.

For those of us who are fortunate enough to remain employed, it’s a good time to re-evaluate priorities and spend a few minutes thinking of how you would fare if they showed up at your desk with the proverbial cardboard box. Do you have an emergency fund? Do you have life insurance or disability coverage separate from what your employer offers? What would it take to get health insurance on your spouse’s plan or in the marketplace? Is your resume up to date? I hate to be doom and gloom, but given recent movement in the industry, it’s worth your while to get a plan in order, even if you never need it.

Have you been impacted by a layoff, reorganization, restructuring, or other synonyms? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/25/18

Health care IT company CareSync shuts down, laying off 292

The Tampa paper provides more details about CareSync’s abrupt closure last Thursday, including the fact that founder and CEO Travis Bond unexpectedly left the company several weeks before, and the interim CEO assured employees last Monday that the company was “on incredibly good financial footing.”

Amid cost cuts, Qualcomm eyes partial sale of health tech subsidiary Qualcomm Life

Cost-cutting Qualcomm is seeking a buyer for a majority stake in its Qualcomm Life subsidiary, which includes the 2net remote patient monitoring system and Capsule medical device integration platform.

Allscripts offering buyouts

Politico reports that Allscripts is offering voluntary retirement to a large number of employees.

Monday Morning Update 6/25/18

Top News

The Tampa paper provides more details about CareSync’s abrupt closure last Thursday:

• Founder and CEO Travis Bond had  left the company “unexpectedly” several weeks before.
• The interim CEO assured employees last Monday that the company was “on incredibly good financial footing” because it was about to be acquired by Bill Smith, the founder of grocery delivery company Shipt.
• Smith said at an all-hands employee meeting last Monday (photo above), “My family will own 100 percent of the company going forward. We’re making a very significant financial commitment to the company, and my perspective on this is that we’re going to build this company for the long-term. I didn’t come into this thing to flip this company in a couple years … I don’t want you to have to worry about where your next paycheck is coming from.”
• The deal fell through Thursday as the company “ran out of time,” after which employees were told to vacate its two Florida locations immediately as the company would be shutting down at midnight. 
• 292 employees lost their jobs. They will not receive severance payments and their health insurance was immediately terminated. 
• CareSync announced its closure on its website, but says its servers will remain operational so that customers can continue to access their medical information.

HIStalk Announcements and Requests

A slight “most” of poll respondents say their employer hasn’t laid people off in 2018. Layoffs are business as usual for many companies, it seems. Maybe that’s a more face-saving option for employees who would otherwise be fired – the health system layoffs I’ve had a hand in orchestrating were all designed to part ways with subpar performers without having to go through the internal and legal challenges of firing them.

New poll to your right or here: do you admire and respect the highest-ranking executive of your employer?

Webinars

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

Acquisitions, Funding, Business, and Stock

Cost-cutting Qualcomm is seeking a buyer for a majority stake in its Qualcomm Life subsidiary, which includes the 2net remote patient monitoring system and Capsule medical device integration platform.

The New York Times covers Humana’s acquisition of two for-profit hospice companies that made it the country’s largest hospice care provider, noting that profit margins are high.

Politico reports that Allscripts is offering voluntary retirement to a large number of employees.

Sales

Memorial Healthcare (MI) chooses CloudWave to implement Meditech Expanse.

Decisions

• Cozad Community Hospital (NE) went live with Evident supply chain management in May 2018.
• Arkansas Children’s Hospital System (AR) will go live with Workday supply chain management software on July 1, 2018.
• Holton Community Hospital (KS) switched from Medhost to Athenahealth on June 19, 2018.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.

Announcements and Implementations

A Reaction Data report finds that negative opinion about payers acquiring vendors has increased, as has hesitation about sharing information with those companies.   

Privacy and Security

A JAMA Network op-ed piece co-authored by former CMS administrator and IHI President Emeritus Don Berwick, MD, MPP says HIPAA causes “serious obstacles to patient care” as misinformed providers refuse to share information with each other and to provide information to family members. The authors note that any time a clinician or clerk says, “I wish I could tell you but HIPAA won’t let me,” they are likely untrained or working under misguided organizational policies. They recommend:

• HHS should undertake a study of how often the HIPAA privacy rule is misinterpreted and the impact that has on patients
• HHS OCR should publish model policies and procedures
• HHS should create and enforce penalties for failing to release patient information to treating clinicians and create a ‘’wall of shame” to call out repeat offenders
• Professional societies and patient advocacy groups should mount campaigns to clinicians and patients that call out common misinterpretations of HIPAA

Other

The Madison newspaper describes the VA’s early success in rolling out Epic’s scheduling system. Lead contractor Leidos says it can implement the entire VA system on the system in two years for $350 million versus its contract that calls for a five-year implementation at a cost of $624 million, although the VA hasn’t committed yet or announced its plans following its selection of Cerner. 

Former doctor Elisabeth Rosenthal’s New York Times opinion piece says that the White House’s detail-light hopes that encouraging free-market principles to bring drug prices down hasn’t worked historically, as drug companies keep raising prices as a group even as competing products are introduced. It notes that lifesaving leukemia drug Gleevec – invented by a researcher who didn’t seek a patent for it and never made a penny from it – cost $26,000 when it was first marketed in 2001 and has spawned several competing products since, but all of them now cost $150,000 per year.

I received several emails that provided details about the reorganization of Ascension Information Services in which somewhere between 200 to 1,000 employees were rumored to have been let go:

• AIS was ordered by Ascension to reduce its FY2019 budget by $155 million
• It will retire some legacy systems and reduce the use of contractors such as Cerner and Kaufman Hall
• Some employees expressed anger that they weren’t told about the layoffs in advance, that management won’t confirm how many people were let go, and AIS’s lack of transparency about any changes that would affect its Cerner, Epic, and Meditech teams.
• Employees were escorted out of the building and weren’t allowed to retrieve their personal items, which were boxed up and delivered to them

Sponsor Updates

• Medicity and Philips Wellcentive will present at the Internet of Health event June 26-27 in Boston.
• Bill Macaitas (Slack) joins Liaison Technologies in a brand advisory role.
• Kyruus releases its ProviderMatch for Consumers solution in Spanish.
• Vyne Medical publishes a new case study, “Standardizing Patient Estimating to Improve Upfront Collections.”
• Meditech will host the 2018 6.1/Expanse Revenue Cycle Summit June 28-29 in Foxborough, MA.
• Navicure/Waystar will exhibit at the AAHC Conference Expo June 27-28 in Scottsdale, AZ.
• Netsmart will exhibit at Post-Acute 360 Strategy & Solutions Conference June 25-27 in National Harbor, MD.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the Indiana Rural Health Association Conference June 26-27 in French Lick, IN.
• OmniSys will exhibit at Cardinal Health RBC June 27-30 in San Diego.
• Recondo Technology’s automated RCM suite achieves HFMA Peer Review Status for patient access and business office software.
• Experian Health publishes a new white paper, “Driving customer engagement in the healthcare financial journey.”
• WebPT will exhibit at the Next APTA Conference and Exposition June 27-30 in Orlando.
• ZappRx will exhibit at the Pulmonary Hypertension Association’s annual meeting June 29-July 1 in Orlando.

Blog Posts

• Unsurprisingly, physicians aren’t thrilled with their EHRs (Medicomp)
• Gaining Patient Buy-In for Chronic Care Management (Lightbeam Health Solutions)
• Customizing Patient-Centric Solutions for Better Care: Clinical Communication that Improves Resident Training (PMD)
• Highlights from the 2018 APIC Conference (LogicStream Health)
• From Program to Business Model: Using Population Health Management to Drive Value-Based Care (Medecision)
• Top 5 Things Your Patients Want from the Patient Billing Process (Navicure/Waystar)
• 10 Tips for a Smooth EHR Implementation (Netsmart)
• R-E-S-P-E-C-T (PatientKeeper)
• How Providers Can Get the Most Out of Their Patient Portals (PokitDok)
• Increase Hospital Collections with 3 RCM Tips (The SSI Group)
• Will critical alerts finally replace pagers? (Voalte)
• Live Well, Age Well – and Communicate Well – at Covia (Vocera)
• The Tech Effect: 3 Ways Your PT Support Staff are Ruining the Patient Experience (WebPT)

Contacts

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

Weekender 6/22/18

Weekly News Recap

• CareSync closes without warning amid rumors that the sale of the company fell through
• McKesson is among the rumored potential acquirers of prescription discount coupon site GoodRx, which could fetch up to $3 billion
• Surgeon, professor, and journalist Atul Gawande, MD is named CEO of the new healthcare venture of Amazon, Berkshire Hathaway, and JPMorgan Chase
• House lawmakers will create an oversight subcommittee to monitor the VA’s $10 billion Cerner implementation
• Quest Analytics acquires BetterDoctor
• Verscend will acquire healthcare payments vendor Cotiviti for $4.9 billion
• Walmart patents a system for storing a patient’s vital medical information in blockchain database housed in a wearable device
• A judge rules that MD Anderson Cancer Center (TX) must pay $4.3 million in penalties for HIPAA violations stemming from three data breaches and non-compliance in following up with device encryption
• The US Attorney indicts Theranos founder and CEO Elizabeth Holmes and former President and COO Sunny Balwani for fraud
• IBM Watson Health executives tell employees that the company will scale back its hospital pay-for-performance tools business

Best Reader Comments

A few weeks ago our CEO bought some branded bike jerseys for those of us participating in a fundraiser. The jerseys are pretty sharp looking and fit well so I’ve been wearing mine frequently. It has definitely been in the back of my mind that I’m wearing a billboard and any perceived misbehavior of mine could look bad for the company. (RobLS)

The issue is not them documenting “not taking.” The issue is that the “not taking” doesn’t remain and I have to say I’m not taking the med every at every visit. Can you imagine if you’d been on an EHR for 70+ years and have to now rattle off 100 different medications that you’re not taking since you were born? Still think it’s a good design decision and patient to blame? (AC)

I hear so many complaints about how EHRs are ruining the practice of medicine by requiring doctors click this and that to document that they’ve reviewed medications, acknowledged allergies, etc. and I have to ask: what were you doing before? (HIT Girl)

What diligence process did Walgreens use to vet Theranos? They were actually marketing this stuff to their customers. I have personally been at VC retreats where Walgreens was proudly preening themselves about their Theranos partnership and the VCs were fawning all over them. (Charlie Harris)

It was so clear to me [about suicide] that this was a medical problem as obvious and in need of treatment as much as if he’d had a bad kidneys or heart disease; his brain was not functioning the way it was supposed to. Unfortunately the country he lived in was (and is) notorious for their total failure in the mental health department, and what should have been an emergency inpatient admission with immediate intervention became his wife, his daughters, his sister, and friends doing everything they could to keep him alive until he could be seen by a doctor. He was failed, and his family was failed. (HIT Girl)

Watercooler Talk Tidbits

Readers funded the DonorsChoose grant request of Ms. T in Texas, who asked for a STEM bundle for her kindergarten class. She reports, “Besides sparking creativity in the classroom, the STEM activities help the students dig deeper and use higher order thinking skills to create different things. These items donated have greatly impacted some of our children that have special needs and behavioral issues. For those students with behavioral issues, these items have helped the student stay focused during Center time and shown the teachers those children’s creative side. It has help those special needs students by allowing them to tinker with the items and also keep them engaged during Center time. The teachers in Room 1 greatly appreciate your generosity in donating to our classroom.”

Healthcare billionaire Patrick Soon-Shiong closes his $500 million acquisition of the Lost Angeles Times, San Diego Union-Tribune, and several community newspapers from Tronc. Tronc, the former Tribune Publishing, has also announced that it will revert to its old name following the ongoing ridicule since its 2016 rebranding that attempted to make the company seem more contemporary, a name that major shareholder Soon-Shiong had called “silly.” The Tronc name was advocated by former chairman Michael Ferro, who has since resigned following sexual harassment allegations. He was also chairman of Merge Healthcare, sold to IBM for $1 billion in 2015.

The closure of CareSync is big news considering the company had raised at least $50 million and had announced rosy hiring projections. Here’s a timeline:

• February 2008 – Travis Bond sells his EHR and physician practice services vendor Bond Technologies to MediNotes, which acquired by Eclipsys for $45 million a few months later
• September 2011 – Bond forms CareSync to obtain and manage the medical records of patients
• July 2014 – co-founder Florida State Rep. Jamie Grant is cleared of ethics violations involving his alleged use of $2.5 million of county economic development grants to fund his startup LifeSync Technologies, which created CareSync
• October 2014 – raises $4.25 million
• February 2015 – adds services to help practices collect payments under what would later become CMS’s Chronic Care Management program
• October 2015 – raises $18 million
• January 2016 – joins Athenahealth’s More Disruption Please program
• February 2016 – fills three new VP positions
• December 2016 – moves its office to a 51,000 square foot building in the Tampa area and announces that it will hire 350 employees in the next year, increasing headcount to 500
• January 2017 – fills four new executive positions
• June 2018 – the sale of the company falls through and all employees are ordered to leave the premises immediately, apparently with no severance pay or COBRA insurance option

The New York Post observes that companies are selling their private jets, noting that the announcement by GE and Athenahealth preceded the dismissal of their chief executives.

Intel forces CEO and board chair Brian Krzanich out for violating the company’s non-fraternization policy by having a relationship  with another Intel employee.

IBM touts its AI technology by having its Project Debater challenge two experienced debaters, perhaps trying to rekindle interest from its “Jeopardy” glory days as Watson Health has achieved little since. Project Debater argued in favor of telemedicine, saying with humorous intent that it believes in the power of technology, while the human debaters said that telemedicine doesn’t offer the hands-on power of a doctor or nurse.

Reaction to the hiring of Atul Gawande, MD as CEO of the non-profit healthcare project of Amazon, Berkshire Hathaway, and JPMorgan is mixed. Some experts noting his vision, story-telling abilities, and past criticism of the healthcare system, while others question his lack of experience in running a large enterprise and his plans to continue working as chairman of Ariadne Labs, surgeon, and New York Times author. Said one, “It starts to feel fundamentally unserious if you’re not hiring a full-time CEO. If you’re transforming healthcare, you’re reshaping the economy of Germany, effectively. It’s not a part-time gig.”

In Case You Missed It

• News 6/22/18
• EPtalk by Dr. Jayne 6/21/18
• News 6/20/18
• HIStalk Interviews John Talaga, EVP/GM, OnPlan Health
• Curbside Consult with Dr. Jayne 6/18/18
• Monday Morning Update 6/18/18
• What I Wish I’d Known Before … Considering or Attempting Suicide or Losing a Friend, Family Member, or Co-Worker To It

Get Involved

• Join my Rolodex to provide occasional news reaction or ideas
• Contribute regularly as a provider CIO, IT director, or informatics nurse (anonymous or not)
• Be interviewed (providers)
• Deliver an educational webinar (providers)
• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 6/22/18

Tech company once lauded for growth shutters Tampa office suddenly, leaves over 100 without jobs

Chronic care management company CareSync closes amidst bankruptcy rumors.

Wildflower Health Acquires Circle, an Innovative Mobile Health Business Incubated by Providence St. Joseph Health

Wildflower Health acquires Circle and its EHR-compatible pregnancy and parenting app for an undisclosed amount.

Developing Software Precertification Program: A Working Model

The FDA updates its software pre-certification program guidelines to emphasize benefits for startups and small companies that haven’t yet established a track record of reliable development.

News 6/22/18

Top News

Chronic care management company CareSync shuts down. Reader Holy Mackerel alerted me to the development: ”Shipt founder Bill Smith offered on Monday to buy 100 percent of company stock for $7 million. Keeping in mind that investors poured in $79 million, he’d essentially be buying at $0.10 on the dollar. Bill backed out of the sale today. CareSync informed all employees at 9 AM of the news, and told them doors were closing and they had to leave by 10 AM.” Social media posts from disgruntled, former employees point to bankruptcy as the cause of the abrupt closure, which has left over 100 jobless.

Reader Comments

From ml: “Re: Ascension IS. On June 14th, 2018, Ascension Information Services eliminated over 450+ positions throughout the US. This included directors, upper level as well as mid-level managers, and the majority of employee’s being IT at both the senior and junior level. This vast amount of cuts came as a shock to most employees. AIS was told from their parent Ascension Health that for FY18 to cut $100 million from their budget and now for FY19 starting July 1, 2018, they were told to cut another $155 million. This obviously included headcount since they were not even able to cut the $100 million from 2018.” Unverified.

Webinars

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

Check out the recording of Thursday’s webinar titled, “Healthcare Organizations: Operationalizing Data Science Models.”

Acquisitions, Funding, Business, and Stock

Wildflower Health acquires Circle for an undisclosed sum. Circle’s EHR-compatible pregnancy and parenting app was developed by providers and the digital innovation team at Providence St. Joseph Health (WA).

CNBC reports that prescription drug comparison pricing and coupon company GoodRx is considering selling itself. Analysts predict it will go for between $1.5 billion and $3 billion. Co-founded by Yahoo and Facebook veteran Doug Hirsch, the company has been around since 2011.

Verscend Technologies will acquire healthcare payments technology company Cotiviti for $4.9 billion. Verscend is backed by Veritas Capital, which acquired GE Healthcare’s Value-Based Care Division earlier this year for $1 billion. Veritas sold off Truven Health Analytics to IBM Watson Health for $2.6 billion in 2016.

People

Surgeon, professor, and author Atul Gawande, MD will become CEO of Amazon, Berkshire Hathaway, and JPMorgan Chase’s new nonprofit healthcare venture, effective July 9. The still unnamed company will operate as an independent entity out of Boston. Gawande briefly mentioned his new gig at the end of his AHIP keynote: “I’ll only say it is a long target and I’m lucky to have an expectation that we’re going to take on the kinds of problems I’m talking about over the next decade. It’ll be gradual progress and there won’t be instant solutions.”

Sales

• Piedmont Healthcare (GA) will implement Patientco’s billing and payment technology.
• Parkview Medical Center (CO) selects clinical decision support, and referral and case management software from Pieces Technologies.
• Mount Sinai Medical Center (FL) chooses Voalte’s smartphone-based communication and alert system.
• OhioHealth signs a three-year agreement with Clearwater Compliance for cyber risk services.
• Neshoba County Hospital and Nursing Home (MS) will convert its disparate digital and paper medical record and billing systems to Cerner.

Announcements and Implementations

Richmond University Medical Center (NY) implements population health management tools including analytics, risk stratification, care management, and reporting from Lightbeam Health Solutions.

Omada Health adds programs for hypertension and type 2 diabetes, plus medication management and remote monitoring features, to its digital therapy offerings for employers and payers.

Beaumont Health (MI) deploys HealthEC’s population health management technology.

Marshall Browning Hospital’s (IL) clinics will go live on Meditech July 2.

Government and Politics

Members of the House Committee on Veterans’ Affairs will create a subcommittee devoted to keeping a close eye on the VA’s EHR overhaul and other major IT projects. Committee Chairman Phil Roe, MD (R-TN) is especially insistent on oversight given his own experience with health IT: “Having personally gone through a transition to a new health record system in private practice, I know how much potential there is for a project like this to be a huge and expensive disruption.”

A year after its debut, the FDA updates its software pre-certification program guidelines to emphasize benefits for startups and small companies that haven’t yet established a track record of reliable development. The FDA plans to open up its pilot program, which initially accepted nine fairly big-name companies, to a broader applicant pool next year.

Pending Congressional approval, HHS will be renamed the Department of Health and Public Welfare if it takes on the $70 billion food stamp program outlined as part of President Trump’s proposed government overhaul.

Former VA Secretary David Shulkin, MD shares why he believes competition – not privatization – will be key to the VA’s success as it works towards offering veterans greater access to care from non-VA providers:

“Although competition alone is not sufficient to improve quality, it can help to modernize performance standards, lead to new management practices within VA medical centers, and move the VA away from the possibility of privatization. Competition also ensures that private-sector providers that wish to care for veterans adhere to the highest quality standards — and formalizing those standards through legislation would allow the VA to better fulfill its responsibility to veterans and taxpayers. Veterans deserve a continually improving health care system, and the best way to ensure that they receive it may be to support the VA at levels that allow it to successfully compete with the private sector.”

Privacy and Security

Passwords are losing relevance, yet gaining in popularity.

Other

This extremely small study looks at the technical challenges of integrating patient generated-data from the Asthma Health app with Epic’s MyChart. Noted pain points included device maturity, lack of Android compatibility, and patient and provider training.

We’ve still got a long way to go.

Sponsor Updates

• EClinicalWorks will exhibit at the California Rural Health Conference June 26-27 in Folsom, CA.
• Premera Blue Cross will use InterSystems HealthShare software to aggregate health data from HIEs, EHRs, and claims to build a better picture of its members.
• Kyruus will host its fifth annual Thought Leadership on Access Symposium (ATLAS) October 15-17 in Boston.
• Experian Health achieves HITRUST CSF Certification.
• Agfa HealthCare announces that the latest version of Enterprise Imaging is operational in 21 healthcare systems throughout North America.
• Kern Health Systems (CA) goes live with the second implementation phase of its ZeOmega’s Jiva population health management software.
• Meditech announces that 150 hospital customers have received ‘A’ grades from Leapfrog.
• Philips Wellcentive publishes a new white paper, “Funding the transformation to value-based care: Seven strategies for success at each step of the maturity curve.”
• Computerworld names Health Catalyst one of the best places to work in IT for the second year in a row.

Blog Posts

• A Community Tackles the AIDS Crisis (EClinicalWorks)
• Overcoming the Revenue Integrity Challenges of Telehealth (Hayes Management Consulting)
• 3 Essential Elements for Post-Go-Live Training (HCI Group)
• The Evolution of Behavior Change (Healthwise)
• This Pride Month, let’s push for a more inclusive workplace (Nordic)
• Ask Alexa and receive … healthcare? (Hyland)
• Big Retail, US Congress embrace EPCS in growing push to require E-prescribing for opioids (Imprivata)
• Patient Advocates: The Other Consumer (Influence Health)
• The Case for Online Scheduling (Kyruus)
• Electronic Health Records Don’t Reduce Administrative Costs – Mobile Charge Capture Does! (PMD)
• Nursing’s Hidden Leadership Gap: Why Every Hospital Needs a CNIO (Spok)
• Using Data to Reduce New Cases of Opioid Addiction (Leidos Health)
• Q&A: How women can lead the way toward healthcare IT’s future (Meditech)
• How Culture Can Positively Impact Healthcare Outcomes (Dimensional Insight)

Contacts

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

EPtalk by Dr. Jayne 6/21/18

I was excited to learn that the Amazon-Berkshire-JPMorgan health care venture has selected Atul Gawande MD as its CEO. My first reaction was to wonder how he was going to fit this into his schedule, given his responsibilities as a surgeon, educator, author, and more. Although Gawande will assume the CEO position on July 9, he will be continuing in his roles at Harvard and Brigham and Women’s Hospital. He will, however, move from executive director at Ariadne Labs to the role of chair. Initially, Amazon-Berkshire-JPMorgan set a goal to identify technologies that would enable “simplified, high-quality, and transparent health care at a reasonable cost.” We don’t fully know what that will mean, other than we can probably count on checklists being involved. Given the scope of what it could mean, I hope he has some friends at Harvard working on a clone. I also hope someone comes up with a name for the company in short order.

Jeff Bezos, Amazon CEO, noted: “We said at the outset that the degree of difficulty is high and success is going to require an expert’s knowledge, a beginner’s mind, and a long-term orientation. Atul embodies all three, and we’re starting strong as we move forward in this challenging and worthwhile endeavor.” I’m a huge fan of Gawande’s work and recently finished his book “Being Mortal.” I found it to be thought-provoking, heart-breaking, and inspiring all at the same time. I’m looking forward to seeing how this progresses, and if he’s looking for a CMIO fan girl, I can be available at a moment’s notice.

Speaking of being a fan, the Honor Flight Network is right up there on my list. Its regional affiliates work tirelessly to enable our veterans to visit their memorials in Washington, DC. Unfortunately, space on flights is limited and many veterans are aged, ill, or otherwise unable to travel. Hospice provider Vitas Healthcare is helping bridge that gap, bringing the memorials to veterans in the organization’s care. These “Virtual Reality Honor Flight” experiences are pre-recorded visits led by retired military tour guides, and provide a 3-D tour of the WWII Memorial, Korean War, and Vietnam War Memorials, Women’s Memorial, and Arlington National Cemetery. The first virtual tour was conducted in Atlanta, and Vitas hopes to share this experience with its veteran hospice patients in Georgia and other states in the future. Kudos to Vitas for thinking outside the box and helping honor our veterans.

Given the tight margins in the healthcare industry, I’m surprised that patient-facing organizations don’t demand better solutions from their vendors, and that vendors don’t provide better options. One of my medical providers has separate portals for clinical information and bill pay, which makes very little sense from not only a patient engagement standpoint but from a practice management standpoint. Maybe there are contractual issues, maybe they think their vendor’s portal is poor on the collections side, or maybe they just don’t know better. I’d love to be able to ask in situations like that but don’t want to wind up enabling free consulting services while I’m freezing in a paper gown.

DrChrono has teamed up with Square to incorporate payment processing into the EHR. Practices can now save patient credit or debit card information, and can collect payments anywhere within the clinic workflow or remotely. Patient balances are automatically updated, which should improve cash flow with minimal labor cost. Existing Square customers can connect their accounts for a seamless transition. The ability to collect payment at various points in the workflow rather than just at the front desk or checkout is key, especially in smaller practices that may be maximizing staffing through cross-training or novel workflows. In my original solo practice, we didn’t have enough staff to have a check-out person, and the medical assistants often did the honors of booking follow-up appointments and taking care of labs and referrals before the patient left the exam room. Being able to have them collect and issue a receipt would be a plus, especially if you’re working with a system that can estimate patient portion due. I have used Square for various charity events and fundraisers and found it to be reliable. It’s also easy enough that a Cub Scout can set up the inventory and charge master functions.

Although I’m a clinician at heart, I love digging into financial and revenue cycle business problems. It’s amazing what goes on out there, particularly when a client doesn’t understand the power of their practice management system. I had one client that was processing refunds on individual patient encounters without checking to see if the patient had an overall patient balance. When the patient came in for a post-operative follow up and was erroneously charged a copay during the global billing period, they refunded the $25 (which incidentally cost them another $6.50 to have the check cut) once they received the communication from the payer. There wasn’t a process, automated or human, to identify the $900 balance the patient had outstanding on his surgery. It costs money to keep sending out paper statements, and the cost to the practice just grows. Those little things add up over time, and I’m always excited to be able to identify these opportunities for practices to fix their processes.

This week has been one of the more challenging travel weeks I’ve experienced in a while, with crammed airport parking lots, oversold flights, and weather delays that made me miss a much-anticipated dinner with a friend whose fair city I was visiting. It’s the height of family travel season, so as a road warrior I try to cut some slack to the families with fussy kids, people racing through the airport, and those who don’t know that your carry-on goes under the seat in front of you rather than trying to stuff it into the space below your own seat. However, there is no slack cut for healthcare vendor reps who act boorishly, fail to observe basic airport courtesies, or get sloppy drunk while wearing corporate-logo shirts and carrying logo backpacks. Be on alert folks – next time I’m going to name names. For now, we’ll just call it “bronchoscopy reps behaving badly.”

Does your company prohibit alcohol consumption while sporting the brand? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/21/18

GoodRx, a service for finding the best price on prescription drugs, is in sale talks for up to $3 billion

Prescription drug comparison pricing company GoodRx is reportedly in talks with several companies, including McKesson, to sell its assets for between $1.5 billion and $3 billion.

Amazon, Berkshire Hathaway and JPMorgan Chase Appoint Dr. Atul Gawande as Chief Executive Officer of Their Newly-Formed Company to Address U.S. Employee Healthcare

Surgeon, professor, and journalist Atul Gawande, MD will become CEO of Amazon, Berkshire Hathaway, and JPMorgan Chase’s new healthcare venture, effective July 9.

Special congressional panel to scrutinize VA’s medical records overhaul

Rep. Phil Roe, MD (R-TN) and Tim Walz (D-MN) will create a House Committee on Veterans’ Affairs subcommittee that will keep a close eye on the VA’s EHR overhaul and other major IT projects.

Morning Headlines 6/20/18

Quest Analytics Acquires BetterDoctor to Create First Health Plan Platform to Ensure Network Adequacy, Provider Data Accuracy and Improved Member Experience

Healthcare provider management and network access technology company Quest Analytics acquires provider management system vendor BetterDoctor.

Ascension Debuts Subsidiary to Help Other Companies Succeed Through Process Automation

Ascension’s shared services subsidiary launches Agilify, which will offer help with intelligent process automation.

Veritas Capital-backed Verscend to Acquire Cotiviti for $4.9 Billion

Verscend Technologies will acquire healthcare payments technology company Cotiviti for $4.9 billion.

News 6/20/18

Top News

Walmart patents a system for storing a patient’s vital medical information in blockchain database housed in a wearable device.

Reader Comments

From Uncle Carbuncle: “Re: IT department names. I’ve seen it go from DP to MIS to IT and now sometimes to technology services.” I would add “information services” to your list. I once worked in a health system’s IT department that used that name, I had a pretty great office in the executive building near the flagship hospital’s entrance. Many early mornings a patient or a visitor would exit confused from the elevator and follow the light to my door (since I was usually the first one in the office suite). They had seen the “information services” sign on the sidewalk close to the hospital’s entrance and were looking for directions. I actually enjoyed riding back down the elevator with them and walking them to the front door, especially since I’m sure some of them were nervous. I also knew that their way-finding challenges were just beginning since we had a remarkably unhelpful system of colored floor lines, puzzlingly named zones, and signage that failed to overcome user-unfriendly hallways created by constantly tinkering with the available space in ways that left even employees lost at times.

From Electric Avenue: “Re: your list of sponsors that are leaving. Did you insult them with something you wrote or failed to write?” Never, as far as I know, since my sponsors understand that they don’t get editorial control or the option to post fluff pieces on HIStalk like other sites offer. The most common reasons for dropping are: (a) the company’s low-level marketing person who was assigned to deal with us leaves and nobody left knows anything; (b) the company is acquired; (c) they’re out of money; or (d) a new marketing VP is trying to score points by cancelling any relationships they didn’t personally initiate. The first reason is by far the most common – turnover in vendor marketing departments, especially among the less-senior folks, is apparently astronomical. 

HIStalk Announcements and Requests

I forgot to mention another gratifying aspect of my unplanned urgent care visit this past weekend that happened while taking a mini-vacation way out in the sticks. I was worried whether my problem required an ED visit and recalled that my new concierge service includes having the personal cell number of my solo practice PCP. I reluctantly called him just after dawn on Saturday morning. My doc was perfectly caring, thoughtful, and supportive in suggesting a plan of action. I told him how much I hated waking him up and he reassured me with, “that’s what I’m here for.” It’s an amazing deal for an all-inclusive price of $60 per month, which includes many lab tests, imaging procedures, minor surgical procedures, and at-cost prescriptions. He treats me like a valued customer with whom he has a long-term relationship that benefits us both. I only hope he doesn’t go broke in hesitating to price his services more reasonably.

Webinars

June 21 (Thursday) noon ET. “Operationalizing Data Science Models in Healthcare.” Sponsor: CitiusTech. Presenters: Yugal Sharma, PhD, VP of data science, CitiusTech; Vinil Menon, VP of enterprise applications proficiency, CitiusTech. As healthcare organizations are becoming more adept at developing models, building the skills required to manage, validate, and deploy these models efficiently remains a challenging task. We define operationalization as the process of managing, validating, and deploying models within an organization. Several industry best practices, along with frameworks and technology solutions, exist to address this challenge. An understanding of this space and current state of the art is crucial to ensure efficient use and consumption of these models for relevant stakeholders in the organization. This webinar will give an introduction and overview of these key areas, along with examples and case studies to demonstrate the value of various best practices in the healthcare industry.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Appleton-WI-based healthcare provider management and network access technology vendor Quest Analytics acquires provider management system vendor BetterDoctor.

Sales

Christus Health will implement Vyne Medical’s Trace voice recording and quality assurance platform to identify discrepancies or confusion about the information given to patients.

Announcements and Implementations

Ascension’s shared services subsidiary launches Agilify, which will offer help with intelligent process automation.

A Change Healthcare payer study finds that value-based care is reducing healthcare costs more than expected and now account for two-thirds of payments.

UK-based Medicalchain will explore the potential benefits of blockchain in healthcare with Mayo Clinic. 

A new KLAS report on cybersecurity services (advisory, technical, and managed) finds that CynergisTek leads in breadth of services and number of engagements for advisory and technical services, while Fortified Health Security has the highest number of managed services engagements. The most commonly requested services are performing risk assessments and security program assessments. 

Government and Politics

An HHS law judge upholds HHS OCR’s $4.3 million HIPAA fine against MD Anderson Cancer Center for losing two unencrypted USB drives in violation of its own policies that require encryption.

The pre-existing conditions political football has generated interesting debate, including the Republican argument that guaranteeing coverage and the same premium prices to those who are either sick or well tests well in voter polls … until the question is reformulated to ask whether it’s OK for sick people to pay the same premiums as healthy ones, in which case even many Democratic voters say no. It’s an interesting exercise trying to educate healthcare-uninformed voters exactly how insurance works, who pays and who profits, and how risk pools work to calculate premiums.

Privacy and Security

Washington Health System (PA) suspends at least 12 employees who are suspected of looking at the medical records of a co-worker who was killed when a driver lost control of his car and ran into a WHS building.

Other

An Indiana doctor sues Apple for interrupting his medical practice with the “devious trick” of forcing IOS updates without the user’s approval as a requirement for its further use. He sent Apple a bill for the $200 time he claims he lost and demanded that his phone be returned to the previous IOS version, then filed the lawsuit after Apple declined to do either.

Bloomberg profiles – with an embarrassingly click-baiting headline – the outcome-predicting Medical Brain project of Google. It notes (barely) the failure of IBM Watson Health to accomplish the same goals of reducing cost or improving outcomes. The author’s analysis must have been superficial in failing to note that Google has already tried and failed to “break into the healthcare business” with its miserable, short-term Google Health project.

I missed this article until someone tweeted it out: “Why Doctors are Running Out of Empathy,” a physician’s bleak look at what our healthcare “system” has turned into with some interesting insights:

If we take the word “healthcare” to mean the mishmash of hospitals, doctors, insurance companies, and vendors that profit from our physical and mental maladies, then perhaps it would be more accurate to call [our healthcare system] “sickness-billing” … Government food policies … resulted in a massive increase in calorie-dense, nutrient-poor, and highly processed “foods” in our diet …led to dramatic increases in obesity, diabetes, heart disease, cancer, and autoimmune disorder rates in the United States. The costs borne by Medicare and insurance companies consequently swelled, producing a strained “system” unprepared to handle the increasing need for preventive care. In response to rapidly rising costs, Medicare (to which most insurance companies look for guidance) created a growing number of obstacles to reimbursing doctors and hospitals, and all payers followed suit. These obstacles started as documentation-focused rules, requiring doctors to record a certain number of data points for each medical visit, otherwise reducing reimbursement. This is why your doctor, during your visit for an ankle sprain, may ask if you have had any constipation, vaginal bleeding, or ringing in your ears … EMRs dramatically reduced physician productivity. This was primarily because the EMR companies got away with designing software with horrendous user interfaces and user workflows .. . the Internet buzzed with stories of Epic bullying anybody who criticized its software. Can you imagine the backlash if Microsoft or Google tried to place gag orders to prevent criticism of their software?

This says a lot about US healthcare. UK-based drug company Indivior will seek an injunction to halt FDA’s approval of a generic to its opioid addiction drug that generates 80 percent of its $1.1 billion revenue and $320 million profit. It also obtains a restraining order against an India-based competitor that was preparing to launch the generic. Indivior says it will introduce a generic of its own for some reason and will cut its operational costs, Shares dropped 23 percent on the FDA news.

A McKinsey analysis of claims data finds that opioid prescribing patterns vary wildly among doctors:

• Opioid prescribing is widespread and not just the result of clinician outliers
• Geography plays a significant role
• Much of the prescribing resulted from a surgery rather than acute medical care, with up to 70 percent of the patients who underwent specific procedures being given opiate prescriptions
• Prescribing was inconsistent even within a single medical practice, varying by the condition being treated
• Doctors often prescribe opiates to patients who have known risk factors, such as having a history of non-opioid substance abuse, having two or more behavioral health issues, or using more than four doctors or pharmacies to obtain opioid prescriptions in the preceding six months
• Most prescriptions are written by a clinician who isn’t the “quarterback” for managing the patient’s primary problem
• EDs issue relatively few opioid prescriptions

WHO adds “gaming disorder” to ICD-11, saying that it is similar to drug addiction because it can take precedence over the patient’s other activities, they can’t stop playing even after they experience negative consequences, and their sleep, diet, and work performance suffer.  

Sponsor Updates

• Formativ Health will exhibit at HFMA’s annual conference June 24-26 in Las Vegas.
• PeriGen will demonstrate its AI-powered Vigilance fetal and maternal early warning solution at AWHONN Connection June 23-27 in Tampa.
• North West Anglia NHS Foundation Trust goes live with Agfa Healthcare’s enterprise imaging for merged Peterborough City, Stamford, and Hinchingbrooke Hospitals.
• Boston Software Systems signs a multi-year contract with a national health system for RPA, EHR, and data optimization services.
• Chief Executive profiles CarePort Health CEO Lissy Hu, MD.
• The Tech Tribune includes CareSync in its list of “10 Best Tech Startups in Florida.”
• Kyruus will host its Fifth Annual Thought Leadership on Access Symposium (ATLAS) in Boston October 15-17.
• CenTrak reports significant growth in its hand hygiene business and an increase in hospital compliance rates.
• Change Healthcare publishes a new payer study, “Finding the Value: The State of Value-Based Care in 2018.”
• CoverMyMeds will exhibit at the ASAP Mid-Year Conference June 20-22 in Palm Beach, FL.
• The Cleveland Plain Dealer recognizes Direct Companies, the parent company of Direct Consulting Associates, as a Top Workplace in Northeast Ohio for 2018.
• Divurgent publishes a new health system case study, “Success Story: Windows 10 Upgrade.”

Blog Posts

• For Phoenix Children’s Hospital, success was just the beginning (Medicomp)
• The Power of Invisibility (Access)
• Center Stage: Ann Mausser, Executive Director, Security Services (Optimum Healthcare IT)
• HIPAA & Texting (AdvancedMD)
• Stanford Health’s CEO can’t remember his life-altering crash. But his approach to care has never been the same. (Advisory Board)
• Precision Medicine at the Point of Care (Aprima)
• Data Protection. Should You Tackle It Alone? (Burwood Group)
• Ensuring a Successful Provider Referral Network: A Heart of CareSync Story (CareSync)
• Cybersecurity Preparations to Make Now (ChartLogic)
• The Tip of the Iceberg (Diameter Health)
• 5 Reasons to Attend Our 2018 Regional User Meetings (Dimensional Insight)
• An Analysis of Employer Services in Urgent Care Over Five Years (DocuTap)

Contacts

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

HIStalk Interviews John Talaga, EVP/GM, OnPlan Health

John Talaga is co-founder and EVP/GM of OnPlan Health of Bannockburn, IL.

Tell me about yourself and the company.

I’m a co-founder of OnPlan Holdings. I co-founded HealthCom Partners, which was acquired by McKesson in 2006. We developed introduced PatientCompass, which was the first online account management tool for hospitals.

OnPlan Health addresses the market shift to high-deductible health plans. Co-founder and CTO David King and I created OnPlan to help hospitals settle balances with patients with high out-of-pocket costs. The business also supports and serves higher education, which has similar challenges to healthcare.

Premiums and deductibles are rising and few people in America have enough savings set aside for even modest unexpected expenses. What’s it like on the front line of health systems?

The shift has hit the boardroom. Over the last couple of years, the level of executive presence on the rev cycle side has increased. You have VPs of revenue cycle and chief revenue officers that you never had in the past. When you hear the term “third payer” — the patient being the new payer — it’s real. Hospitals are having to deal with so much of the self-pay that it’s as much as commercial and Blue Cross, in many cases.

The front lines are asking, what do we do about it? A lot of technology has poured in and has been invested in. Companies are offering automated payment plan functionality, front-end collection at point of service, and scheduling. It’s a form of retail-ization — trying to collect as much as they can up front, but also trying to automate and reduce the cost that it takes to collect on the back end.

You have this new focus of, “The old way of doing things is no longer good enough. We don’t have the staff to be able to do that.” Companies are turning to outsourcing early outs. Some are turning towards financing. But those solutions are expensive and they disintermediate the patient, so they are looking at technology that allows them to work on their own to prevent having to place accounts with those options.

Is the financial conversation that might precede the medical conversation awkward for both the patient and the provider?

It’s a very different environment when you talk about the doctor’s office versus the health system and the hospital. Where my company spends the most time is in the health system, where physicians are part of the health system and are connected to a hospital with the higher cost.

In the doctor’s office environment, there still is an expectation that you’re going to pay for your service. We know what it costs, typically. There’s nothing emergent that comes from that visit. They will bill on the back end and typically patients have the money to pay that.

It’s the surprising bills that come with services that cost more, typically coming from a service that involves the hospital. The patient doesn’t have budget and sometime doesn’t even realize what they signed up for — what their employer provided them for a health plan — until the bill comes. They wonder, why am I getting a bill for $2,500 when I have insurance? Reality sinks in.

It’s this surprise factor that’s difficult on the financial side. Setting those expectations has been a big priority of hospitals. We’re going to do an estimate for you and this is approximately what you’ll owe. They try to collect as much as they can up front, but that expectation carries through after adjudication of the balance.

Is the approach the same for patients who are unable to pay versus those who are simply unwilling to pay?

The expectation is that 80 percent of the patients are willing to pay. They just have to understand what it is they owe. Then they have to have the means.

The introduction of revenue cycle analytics has been positive. Though analytics can be used from a propensity-to-pay perspective to identify the patient’s ability to pay, but also to determine how how much means they have to cover a specific balance. Analytics isn’t just directional. It’s getting to the point where, this patient owes this balance, they have this much left on the deductible, so here’s what they can afford.

That technology is done on the front end. But now more hospitals are also doing it for self -pay as well. How should we approach this patient? What should we offer them to pay as opposed to just asking for the full balance knowing that they’re probably not going to be able to pay it and they may end up in collections? Propensity-to-pay has evolved into revenue cycle analytics.

Those unwilling to pay is going be a difficult one to solve. Those are probably for the collection agencies, simply because you’ve got a different problem than somebody who just doesn’t have the means.

What do health systems do in that case where someone hasn’t made progress on their previous payment plan obligation?

The analytics only go so far. It gives you the profile of this patient at the moment. Hospitals are now taking it to the next level to automate processes and policies to avoid the traditional one-on-one negotiation. In the past, payment plans were set up on a phone call. Somebody who needs help seeks it out and agrees to a payment arrangement.

Now companies are using analytics to provide a payment plan offer proactively. We give them an installment offer that they’re able to pay. And if they’re able to pay that, let’s give them the ability to self-activate without having to call us. That could be by going online or mobile to activate the plan or even writing a check based on what they’re willing to do a payment plan for.

If they take the call center mostly out of it, like 70 percent of those payment plans that are activated, the next step is whether the patient stays on that plan. The rules are in place. You have to make your payments. You can’t miss two payments or you’re going be terminated from your plan. Those patients will be treated differently the next time they come in for service.

It’s working the analytics visibility to the staff, putting it into automation so that they don’t have to do hand-to-hand combat, if you will. But then also being able to utilize what happened when the patient presents themselves back in the office.

Is discounting the initial price for someone who has to pay cash a significant factor in creating the payment plan?

For revenue cycle leaders, the goal is still to get someone to pay in full. The goal isn’t to get them on a plan. But for a segment of patients, that’s the only way they’ll be able to pay. The discounting usually comes in after uninsured discounting, when a patient has a balance after insurance or they owe a patient responsibility. They’re driving incentives such as, you can get on this payment plan and we’re willing to do this for you. But if you pay us in full in the next 30 days, as a prompt pay discount, we’ll take 5 or 10 percent off.

What they’re doing instead is driving discount incentives, mainly post-service, to try and get them to pay off their balance as opposed to getting on a plan. The plan itself should be enough of incentive to pay over a time that makes sense for them.

On the front end, if the analytics are there, they will offer some deeper discounting to be able to get them to pay in full. But again, what you’re seeing is payment plans being set up off the estimates. It’s easier to say, you owe $1,000. Do you want to pay $1,000, or do you want to pay a portion of it? How about we set you up on a plan for $100 a month? Then when your insurance pays, we will adjust your balance and your $100 a month will continue until the end of the term. It’s easier for a consumer to accept that as opposed to just paying some dollars towards a cost they don’t know yet.

I assume it’s not in the best interest of either the provider or the patient to turn a bill over to collections,.

That comes across loud and clear in terms our business and how we position ourselves to serve hospitals. They’re trying to reduce bad debt and the amount of placements that they send to bad debt collections, But also even to their pre-collect, early out vendors. Even though early out vendors are first party, you have hospitals that are turning them over at Day One.

The big concern is, if I’m using this outsource vendor, they’re collecting and I’m paying for balances that maybe the patient would have automatically paid with a payment plan. If I can get some automation in place, then maybe I only have to place accounts that are expensive to early out at a later time. If I’m placing accounts at Day 60 and I’m trying to collect on my own internally before Day 60, then how can I collect as many as I can by settling on payment plans before I have to turn them over to a collections agency?

The whole idea of turning patients over to a collections agency is perceived negatively. They’re trying to keep engagement and patient loyalty so they will come back to the health system. To do that, they want to have that direct interaction with them without having a collection agency asking them to pay their bill.

Do you have any final thoughts?

The revenue cycle leaders are trying to reduce the pain points of increased self pay, so there’s a resurgence of patient financing. You hear about these recourse options for essentially getting a loan to pay off their bills. In terms of financing, the revenue cycle leaders are debating whether to sell their receivables. Where it’s falling is that if they can get more of the functionality and tools with analytics and automation in their system to do it themselves, with the reserves they’re willing to fund for these balances, then they only use financing on the back end for those balances that need long terms. That is the direction that is becoming more acceptable with these leaders, as opposed to one or the other.