News 8/1/18

Top News

HHS OIG fines EClinicalWorks $132,500 for failing to file timely reports of patient safety-related software issues as required by the Corporate Integrity Agreement it signed in May 2017 as part of its $155 million False Claims Act settlement. 

Reader Comments

From Low Slider: “Re: Recondo. Just a point of clarification. Payment Navigation Compass is a white label of Recondo products, not Empowered Access being a Recondo name for Payment Navigation Compass. Recondo has purchased that Advisory Board / Optum client base to be managed by the original manufacturer, Recondo.” Thanks.

From Not KLAS-sy: “Re: KLAS. A former executive recently took a job with one of its high-scoring vendors that financial supports KLAS’s work. Sounds fishy.” I don’t see any harm on that and I don’t think it reflects negatively on KLAS or the vendor. I don’t know who you’re referring to specifically, but if that person had a lot of healthcare IT experience, it’s not unreasonable that they would remain in the industry and end up working for a high-achieving vendor when they were ready to move on. I doubt there’s any pay-for-play at work here if that’s what you are suggesting – if that were the case, the vendor would be better off leaving that person as a KLAS insider instead of hiring them. Regardless, check back in a year, and if the vendor has dropped out of frontrunner status, then maybe you were right. 

HIStalk Announcements and Requests

A reader desperate for all-too-rare good news suggested this question about bosses showing humanity (which might be all-too-rare as well since I’ve received few responses.) I remember when I was fresh out school and running a hospital department and one of my employees died unexpectedly in a biking accident. The associate CEO I reported to insisted that the two of us take the six-hour drive to the employee’s home town to attend his funeral, with the hospital quietly footing the travel bill. The employee’s family members were amazed to see us there and were touched that we had traveled so far.

Welcome to new HIStalk Gold Sponsor Zen Healthcare IT. The Costa Mesa, CA-based interoperability technology and consulting company offers its Gemini Integration-as-a-Service platform that allows healthcare organizations to outsource their interoperability challenges or just use the company’s enterprise architecture. Gemini is the fastest, most affordable way for healthcare organizations to achieve connectivity between systems and exchange partners, whether it’s one interface or thousands. The company also offers the Stargate IHE on-ramp to Carequality and EHealth Exchange and a FHIR-based clinical data repository.  Its consulting service helps design, deploy, and support use-case driven healthcare integrations. Thanks to Zen Healthcare IT for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Athenahealth reports Q2 results: revenue up 10 percent, adjusted EPS $1.08 vs. $0.51 (both based on a new revenue recognition standard), beating earnings estimates but falling short on revenue. From the earnings call:

• Hospital business remained “relative small” with bookings down year-over-year, and effort will be focused on small hospitals going forward.
• Executive Chairman Jeff Immelt says the company is “moving with a purpose” in considering a company sale, a merger, or continuing as an independent business to “unlock value in the company.”
• R&D was one of few expense categories that increased amidst cost cutting.
• Immelt says the seismic changes in healthcare are forcing clients to figure out their best business model going forward, but they remain supporters of Athenahealth.
• Executives on the called prefaced their responses to analyst questions with “look” 11 times in addressing the questioner, which I usually read as being defensive or dismissive.
• It was a pretty dull call without Jonathan Bush.

Meditech reports Q2 results: revenue up 7.1 percent, EPS $0.65 vs. $0.39. Product revenue rose 28 percent, while services revenue dropped slightly due to customer consolidation.

Teladoc will change its name to Teladoc Health.

Walgreens launches Find Care Now, a marketplace on its website and app that lists alternatives for ED visits — with cash prices  — as provided by Walgreens and its partners, which include several major health systems.

Newly renamed Verana Health (formerly known as DigiSight Technologies) raises $30 million in a Series C funding round led by Alphabet’s venture capital arm. The company’s technology merges EHR data with registries to support drug and medical device development. The company also announces that Miki Kapoor, former CEO of Welltok-acquired Tea Leaves Health, has signed on as president and CEO in replacing Doug Foster, who was apparently demoted to chief strategy officer.

Columbiu, OH-based healthcare AI and workflow automation vendor CrossChx renames itself Olive and raises $33 million in Series D funding round, increasing its total to $73 million.

Former GE Chairman and CEO Jeff Immelt bet the farm on GE Digital’s “digital industrial” and Internet of Things services before he was shown the door, but now the company is shopping for a buyer of part of that money-losing business.

Bloomberg notes that little-known people sometimes become fabulously wealthy, even billionaires, after helping relatives and friends with their tech startups. The parents of Amazon’s Jeff Bezos helped him out with $250,000 in 1995, with those shares now worth up to $30 billion, while the $10,000 his brother and sister provided in 1996 gave them shares now worth $640 million each.

Sales

• Roper St. Francis Healthcare (SC) chooses DocASAP for online appointment scheduling.
• Mercy selects Visage 7 Open Archive and will convert 25 million diagnostic images from its current archive.
• Four-hospital UHS (NY) chooses Epic, according to this video forwarded to me by a reader.

People

Evergreen Healthcare Partners hires Todd Hatton, MHSA (Saint Luke’s Health System) as VP of advisory services.

Kathy Ross, MBA (Stony Brook Medicine) joins Broward Health (FL) as CIO.

Announcements and Implementations

Mary Washington Healthcare (VA) went live June 2 on Epic, hopefully inspiring the health system to create a new “Hamilton”-themed video as it did when announcing Epic as its choice and when calling out its planned go-live.

Virginia Governor Ralph Northam announces that all 129 of the state’s hospitals are live on Collective Health’s network, allowing emergency medical services personnel to access patient information and to display integrated information from the state’s PDMP database and advance directive registry.

Galway Clinic goes live on Meditech Expanse, the first hospital in Ireland or the UK to do so.

Government and Politics

Specialty physicians are complaining about a proposed Medicare change that would pay them a flat fee per patient visit, warning that not being paid more for seeing more complex patients will hurt their incomes, steer medical students away from specialties like rheumatology, shorten visits that would then require follow-up care, or give specialists incentive to cherry-pick just the healthier patients or to stop accepting Medicare entirely. Doctors would have the option to tack on a $67 Medicare bill for more complex visits, which you can bet will be a popular option as, once again, trying to cut healthcare costs means reducing someone’s income and they’ll fight it however possible.

Farzad posts a wise comment about the proposed flat fee rule and the political issues that stand in the way of reducing healthcare costs.

Privacy and Security

Blue Springs Family Care (MO) notifies patients that its EHR was penetrated in a ransomware attack, saying that as a result, it has implemented a new firewall and intrusion detection system and also replaced its EHR with one that encrypts patient data (Jenn contacted the practice, which told her they are moving from E-MDs to EClinicalWorks).

Ancestry.com and 23andMed will provide consumers with a separate consent form to convey their permission for their genetic information to be shared with third parties.

Other

AMA Wire interviews a Regenstrief scientist who lists three reasons that EHRs are hard to use even for digital natives: (a) mobile devices can’t display enough information, so PCs are still the norm; (b) most EHRs were designed in the last century before mobile devices became ubiquitous; and (c) the EHR paradigm is that users look up what they need to know, unlike smart search and voice-powered systems that anticipate user need.

Forty physicians and employees of Dignity Health (CA) who lost their homes in the Carr wildfire are still showing up to work as scheduled.

A new study by the Nation Association of Insurance Companies finds that insurers that sell short-term policies (aka, exclusion-filled “junk” insurance as touted by the White House) pay out just 44 percent in claims versus the ACA-required 80 percent Medical Loss Ratio, meaning those plans generate far higher profits in sticking patients with more of the bills.

An Indiana teen becomes the latest of several hospitalized victims of the Hot Water Challenge, in which YouTube videos dare kids to pour boiling water on an unsuspecting friend or to drink boiling water through a straw.

Sponsor Updates

• Bluetree employees raise $7,000 for local nonprofits RISE and Friends of the State Street Family.
• Burwood Group will exhibit at the NC Tech Leadership Summit August 9 in Pinehurst.
• Carevive Systems publishes a new video, “Acute Myelogenous Leukemia: Treatment Updates and Implications for Older Patients.”
• CoverMyMeds will exhibit at the EMDs User Conference August 5-7 in Grapevine, TX.
• Cumberland Consulting Group will sponsor the Health Plan Alliance Government Programs Value Visit August 6-10 in San Francisco.
• Meditech publishes a podcast titled “Social Determinants of Health and Transitional Care.”

Blog Posts

• ‘The disruptor, not the disrupted’: How Advocate Aurora’s co-CEOs plan to transform health care as a $12B system (Advisory Board)
• Efficient configuration and management with a single point of entry to system administration services (Agfa Healthcare)
• What’s Wrong with Physician Coding? (Apixio)
• 6 ways to take back your medical practice (Bluetree)
• Summer Quarterly Report Preview: Privacy and Big Technology (Datica)
• The Voice of the Nurse Leader in Technology (Spok)
• Four Ways Google Cloud Supports Healthcare IT (Burwood Group)
• 4 Questions with Renee Broadbent, AVP, Population Health, UMass Memorial Care (Optimum Healthcare IT)
• Moving the Needles on Interoperability Part 2: Making the Connections (Casenet)
• Metrics that Matter: Urgent Care KPIs Defined (DocuTap)

Contacts

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

Morning Headlines 7/31/18

Stipulated Penalties and Exclusion for Material Breach

OIG fines EClinicalWorks $132,500 for failing to report patient safety issues as reportable events, per its corporate integrity agreement signed as part of its $155 million settlement with the DoJ last year.

Trump Picks Marine Vet To Take Over Veterans Affairs IT

President Trump nominates Marine Corps veteran James Gfrerer to be the VA’s assistant secretary for IT, commonly referred to as its CIO.

CMS Shares MA Data with Wonks

CMS finally releases an initial year’s worth of Medicare Advantage data with help from health data research organization CareSet.

Curbside Consult with Dr. Jayne 7/30/18

I have to admit I cracked a smile when I heard about the proposal to do away with so-called provider-based billing. I always found that term kind of humorous, since it’s actually hospital and provider billing rather than billing for the provider’s services. It’s always felt like a cash grab by hospitals, who snapped up physician practices and added facility fees without so much as changing a light bulb in the doctor’s office. Physicians who became hospital employees during this time often didn’t realize what they were getting into, only to begin to hear from angry patients who didn’t understand why they were receiving two bills for physician services that previously cost less.

It’s being referred to as “site neutrality,” which although accurate, doesn’t sound very sexy. Payment for a given service would be the same regardless of whether it’s delivered in a physician office or a clinic that’s considered an outpatient department of a hospital. Leveling this charge playing field has been discussed for the last several years; endorsed by Congress and the Medicare Payment Advisory Committee; and was been supported by previous administrations, although loopholes have allowed hospitals continue to take advantage of their cash cow by exempting existing outpatient departments from rate cuts.

Including hospital facility charges for basic outpatient visits serves to drive up costs for Medicare as well as patients. Hospital organizations try to justify the charges by explaining that they need to charge more in different ways to make up for shortfalls due to Medicaid cuts as well as money spent on charity care and to finance all the services that are on standby for patients.

The Hospital Outpatient Prospective Payment System rule released this week aims to end this grandfathering for certain services, including routine physician visits. This would result in hundreds of millions of dollars of savings for Medicare, and by extension, should save patients about $150 million through reduced co-payments. The proposal doesn’t touch most of the procedures where hospitals make a great deal of money, however.

It’s not surprising that hospitals are pushing back and litigation may follow. I enjoyed the Twitter thread that followed Farzad Mostashari’s post about it, with various health IT personalities weighing in on his thoughts. The rule also addresses some drug payment issues and promotes movement of services from inpatient facilities to outpatient settings. The hospital lobby is powerful and it’s not clear whether the rule will stay in its current form.

Of the physicians I’ve chatted with since the rule came out, many are ambivalent about the change. Most are employed physicians who didn’t see any increase in their compensation when their employers started charging facility fees, but they did have patient complaints and some lost patients to independent competitors who didn’t charge facility fees. They’re just happy they won’t have to deal with the negative aspects.

Some of the older physicians appreciated that it might help prolong the solvency of Medicare, allowing them to actually take advantage of it as patients. A few of the surgical subspecialists (who were almost universally independent) had no idea what provider-based billing even was, so that they didn’t have an opinion on site neutrality.

They did have an opinion, however, about the movement of services to outpatient facilities since several of them are involved with ambulatory surgery centers. Under the rule, there will be additional procedures payable at surgery centers along with language to ensure payment parity for ASC procedures using high-cost devices. The goal is to help ASCs be competitive, so it’s not surprising that the surgeons’ ears perked up.

I’ve been following along with the CMS campaign for “Patients Over Paperwork” and just saw the July newsletter. This edition was mostly focused on how CMS is trying to address burden in the context of skilled nursing facilities. There were several comments from stakeholders that were included and I appreciated their candor. One example: “Unfortunately, health care has evolved into this: head in a bed, payer, and a pulse – and that’s it. I think everybody has lost sight of the actual … care of the patient. Nobody really looks at that any more.” That sentiment is true at far too many places of service, not just nursing facilities. We’re violating the basics of what we learned in medical school, treating “the numbers” instead of the patients in front of us. We’re checking boxes and following rules and not truly getting to know our patients or how best to help them.

There were a couple of bright spots in the newsletter, although reading through the lines, they were a little bit tardy. One such bright spot was about simplifying documentation, although the example given was a bit of a slap and a kiss at the same time. CMS apparently updated certain payment rules for podiatrists, orthotists, and prosthetists. Now it is “allowing payment for therapeutic shoe inserts made with current technology.” You got it, folks – CMS required providers to take an actual impression of the patient’s foot for them to be paid rather than using the digital image technology that many foot specialists have been using for years. Why this took so long is baffling, and it makes my arches ache just thinking about it since I had my own orthotics created from a digital scan several years ago. I had no idea Medicare still required patients to step on pieces of foam in a cardboard box that was then mailed off to the lab. I’m sure there are mail carriers across the country that will be glad to not have to pick up the boxes at the practice’s front desk.

I hadn’t seen the newsletter previously, so I’ll have to keep an out for it moving forward. This is only the sixth issue, so I don’t feel too bad about having missed it. There is so much to keep in with in my inbox – a steady stream of government announcements, payer updates, drug recalls, and more. Then, there are the fun things such as reader mail, rumors, and industry gossip. And of course, there are the messages for my actual day job, which pays the bills but isn’t as fun as the former.

What’s your favorite part of your inbox? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Lillian Dittrick, VP of Actuarial and Healthcare Analytics, Health Alliance Plan

Lillian Dittrick, MAAA is VP of actuarial and healthcare analytics at Health Alliance Plan of Detroit, MI and is a fellow of the Society of Actuaries.

Tell me about yourself and your job.

Henry Ford Health System owns a health insurance company called HAP, Health Alliance Plan. I am building for them both their actuarial and analytics function. I am an actuary and an FSA in the Society of Actuaries. I have extensive actuarial and analytics experience for both the payer and the provider. This is a good and exciting fit for me since it’s both of them combined. I feel strongly that payers and providers need to collaborate for both to succeed. We have the same end goals. Whether we’re calling them members or patients, we’re supporting the same people.

Prior to this, I was at Highmark, leading their provider analytics area, and before that, I spent a number of years embedded in a large provider system.

When I hear “actuary,” I think of a life insurance company person who can tell from an Excel worksheet when I’ll die. What is the training of actuaries and how is their analytics approach different?

[laughs] Your comment is more what a life actuary would do. A life actuary is more mortality versus a health actuary, which is morbidity. There are a number of tracks you can go down for an actuary. It could be in more the investment realm, too, and a lot of actuaries are in that space.

Predictive analytics is a lot of the education, which is newer to healthcare, but not newer to many industries. You have to go through a series of exams that have a heavy reliance on math, actuarial science, and modeling in general. It’s really in that modeling space.

Over the last few years, the Society of Actuaries has added specific education that speaks to predictive modeling. They’re revamping their education and recognizing and understanding the importance  of predictive modeling. Actuaries, with that heavy math and modeling education and background, are well suited to do that kind of work in any industry.

Beyond EHR and claims data, what data sources are important for creating a healthcare model?

Both of those are important. It’s important for payers and providers to share that information so they have as complete a picture on a patient as possible.

Also important are social determinants of health. There’s a lot that goes on with a patient that can be used to predict their future healthcare use that you will not find just looking at their claims history. Information about whether they have someone to help them, if they need help getting medications, or if they have transportation issues. People present in the ED or hospital because they didn’t have a way to get to their follow-up appointments. Or, they have a financial barrier to obtaining medications that would keep them out of the ED and hospital. Payers and providers alike, more strongly in the provider realm right now, are recognizing that and are performing assessments to capture that information.

A number of government grants are going on now to help providers work with the community to link people up with all of the resources that may be available, such as social services, that can help fill in those gaps to make sure that people are getting the appropriate care they need, when they need, and where they need it.

Reports suggest that insurers are buying consumer data to, depending on who you believe, either cherry-pick less expensive patients or to create tailored health interventions. What are people doing with less-obvious data sources and what are the ethical issues involved?

That is very much a concern. When SOA did the survey, challenges around HIPAA and regulatory issues came up pretty high as a barrier to implementing predictive analytics. All insurers that I have worked for, because you were speaking more to the insurance side, are very aware of those ethical issues. I haven’t seen them using any data inappropriately. They’re all using that data to try to understand the best care to wrap around a patient. I’m aware of least two places, here and Highmark, that have programs with Lyft to help people get the transportation they need to their appointments. Unless you are able to collect that information, you’re not able to provide that extra level of care that the patient needs to make sure they’re receiving that care where they need it and when they need it.

What are the analytical challenges of trying to draw insights from a population that’s heterogeneous to begin with, but that is also changing all the time?

Not having complete data and those regulatory issues or having the technology and skill to deploy those kinds of models. I don’t think employers always realize that when they have actuaries on the staff, those are the skills they need and the people who are suited to doing that kind of work. They are under-utilizing the skillset in the actuaries they have.

Incomplete data is always on the top of the list. What I have found in my experience is you can do a lot with what you have. You do not need to wait for perfect information. There will always be holes and some gaps in your data. Tools, technology, and methodology can help you fill in some of those gaps. But even with having some gaps in data, you can draw a lot of good conclusions by just going forward with the information that you have.

How could a mid-sized health system create a predictive analytics service and what low-hanging fruit might provide the fastest benefit?

Leverage models that are already created first. There’s a lot of them out there that are good. It’s not like you’d have to re-create the wheel and do all of that coding yourself. There’s models that are available out there that you can utilize that use both claims and EHR data. You can alter them based on what you have.

The larger EHR vendors have embedded predictive analytics in their model that can be leveraged. If you are a smaller organization trying to figure out where to start, especially on the provider side, you can generally utilize models that you have within the vendor that you’re already using.

The low-hanging fruit that I’ve found involve inappropriate ED utilization, inpatient readmissions, and admissions for something that could have been prevented around chronic conditions. I’ve seen models in all of those areas embedded in EHRs. That’s the easiest place for people to start.

University of Minnesota is offering to license an algorithm they developed to predict one-year patient mortality based on EHR data. Is it as simple as just creating a good algorithm and seeing results?

If someone has created an algorithm, you can take it in house and make it fit for your data. It could be that with your population and demographics, you’ll get different results, and maybe you need a variation of that model. I’m not saying it’s a “one size fits all” model, but if a health system or payer has found success with the theme of a model – something around readmissions or blood utilization — then it’s likely that someone else will, too.

Do actuaries get involved on the front lines with convincing clinicians to trust their information and to change their habits?

Yes, absolutely. The success I’ve found is from beginning to end, where we have had the physician and clinical involvement. Both from designing new algorithms and new processes all the way through to having physician champions that are out there helping us. Sometimes they are the ones taking that message out and sharing it with other physicians. I absolutely believe that.

Whoever your audience is, but certainly with the providers, you can’t just dump a whole bunch of data and Excel spreadsheets on people. You need to present it in a way that’s visual, actionable, and tells a story, so that anyone can pick that information up and know the two or three things to work on right now for success in that model solution is that’s being developed. You’re not going to pull it across the finish line unless you have the physician champions as part the build as well as visualizing the information in a way that is easily digestible.

We have mountains of newly electronic information as well as AI and machine learning tools to apply to it. What will be different in five years?

There will be more leveraging of AI, the automation technology that helps us handle that huge amount of data that we’re dealing with today, along with doing a better job of visualizing the data.

Morning Headlines 7/30/18

Defense Healthcare Management System Modernization – Standard Solution Baseline

The DoD justifies paying Leidos up to $1.1 billion more for its EHR implementation by mentioning the unstated cost of adding the Coast Guard while redacting the list of “as a service” requirements and their associated costs.

Vocera Announces Second Quarter Revenue of $42.7 Million

Vocera announces Q2 results: revenue up 8 percent, adjusted EPS $0.09 vs. $0.02.

Beyond Dr. Google: the evidence on consumer-facing digital tools for diagnosis

A literature review finds that consumer-facing diagnostic websites and apps are poorly supported by clinical studies and sometimes offer low accuracy rates.

Monday Morning Update 7/30/18

Top News

The DoD justifies paying Leidos up to $1.1 billion more for its EHR implementation by mentioning the unstated cost of adding the Coast Guard while redacting the list of “as a service” requirements and their associated costs that the VA included in its contract that the DoD had to add after the fact.

DoD says it had to extend the work of Leidos to include EHR standardization since the VA hired Cerner as its prime contractor, such that “contracting with anyone else (other than Leidos) to work with Cerner would create significant redundancies, inefficiencies, and other issues.”

DoD says Cerner declined to provide access to its Clinical Application Services to third parties “to enable competition.”

Allscripts and CACI challenged DoD’s sole-source selection of Leidos for the contract extension, but were rejected with the rationale that the government isn’t interested in bringing another EHR into the mix.

Meanwhile, Leidos says in its earnings call that it will serve as Cerner’s subcontractor in the VA’s implementation, providing services for program management, implementation, help desk, and security.

Reader Comments

From Magic Kingdom: “Re: Orlando Health. Going Cerner.” Unverified. The job description of the CIO who was hired earlier this year said that the health system will be choosing a new EHR after running Allscripts Sunrise for around 15 years. Adventist, the other big system in town, is a Cerner shop, and Orlando Health uses Cerner lab. But nothing’s been announced and I haven’t seen any relevant open position listings. If the rumor is true and the process is far enough along (and I have no knowledge of either), the announcement would probably come Thursday when Cerner post Q2 earnings.

From Health System Exec: “Re: consultants. Is it possible for you to ask where your readers would go to find a list of consulting firms that can handle a large health system’s full ERP implementation? (human capital, materials management, finance and accounting). Gartner? KLAS? Other?” I’ll open it up to readers to post a comment about their sources (not specific consulting firms since that’s not the question).

From RxPriceResearcher: “Re: drug prices. Is there a public or federal database that maintains historical medication prices? For example, I would like to compare the price of Tylenol 500mg from 1990-2017.” Medicaid publishes a database that goes back to 2013. The only source I know otherwise is from Wolters Kluwer and it’s not free. It’s hard to even understand the effect of “price” since the US healthcare non-system involves a hidden web of contractual discounts and rebates that make it less meaningful.

From Vague Gravity: “Re: Optum and Recondo. Confirming Eligible Bachelor’s rumor from Friday with the attached email.” The customer email from both companies says that, as the reader’s rumor said, Recondo has taken over Advisory Board’s Payment Navigation Compass reimbursement product, which Recondo has been reselling under the Empowered Patient Access name. The email notes that both Optum and Advisory Board are owned by UnitedHealth Group, which is a “key shareholder” in Recondo (I don’t think I knew that).

From James: “Re: hospital sleep. Not really news, just confirmation of what we know.” A JAMA Internal Medicine-published survey of 2,000 inpatients in the Netherlands asked a simple question – how did you sleep last night compared to at home? Patients reported sleeping 83 percent less and 70 percent said they were awakened due to external causes, half of those due to hospital staff. Rest was most commonly interrupted by the noise of other patients, medical devices, pain, and toilet visits. I’ve spent just one night in a hospital and it was anything but restful and recuperative, hitting every anecdotal cliche in been awakened by vital sign checks, IV tinkering, hallway staff exuberance, and the racket of beeping and wheezing machines from my own bedside and that of my roommate in what was supposed to have been a private room. I will posit that length of stay would be longer if hospitals had better accommodations, food, and hospitality instead being barely better than a prison, which is probably a good thing since it’s not supposed to be a vacation (not to mention that every hour in a hospital bed increases your chances of being harmed by the never-ending screw-ups).

HIStalk Announcements and Requests

The vast majority of poll respondents don’t want health insurers making coverage or premium decisions based on their harvested, non-medical data, which of course will return to legality once again following the White House’s scuttling of the ACA, which set minimum standards for coverage and policy terms that benefitted even those who buy insurance from their employers. The business of health insurance is interesting since pricing every other kind of insurance — auto, homeowner’s, life, and malpractice — requires the applicant to disclose everything that might affect the insurer’s risk even though those insurers don’t pay out until the subscriber experiences a catastrophic, measurable event, with premiums set by that person’s risk. Health insurance pays routine costs for accumulated health conditions starting almost immediately, yet we don’t want those insurers knowing too much about us. It’s like a reverse Las Vegas, where the house’s lack of information and forced participation gives gamblers the edge, with the solution being that insurers either overcharge and bank handsome profits or pull out of a market entirely, all based on the risk pool they’re stuck with.

This week’s question, based on the Montefiore resident who may be fired over unproven accusations that he posted white supremacist writings under another name – Is it OK to fire an employee over unsavory but legal off-the-job activities? Internet lynch mobs who were raised on TV judge shows love playing armchair jury and going personally after someone who has done or said something they don’t like — even when that person hasn’t been charged with a crime or the information source is unvetted — and companies that are worried about taking a bottom-line hit find it easier to just fire them in publicly shared indignation. Any resemblance to actual legal process is coincidental – it’s short attention span, “I know it’s true because I read it on Facebook and someone is trying to hide it even though I haven’t read a newspaper in years” outrage, because everybody is required to be outraged by everything these days.

I gave the “wish I’d known” series a short vacation since summertime responses were sparse, but I’ll revive it this week with a reader-requested question in a slightly different format.The reader says we need more positive stories and I agree.

Welcome to new HIStalk Platinum Sponsor Apixio. The San Mateo, CA-based company offers an AI-powered data insights platform that creates a comprehensive picture of a patient’s medical history, then applies data classifiers and predictive models that give insights to their health to support delivery of personalized and affordable care. It also offers an efficient, accurate, and complete risk management solution that turns unstructured data into meaningful data to maximize coding efforts while remaining compliant, with an average ROI increase of 400 percent and productivity gains of 4-7x over manual, low-tech methods. Quality measurement expert Darren Schulte, MD, MPP has worked in healthcare analytics and technology for a long time and has been with the company since 2011. Thanks to Apixio for supporting HIStalk.

I always head over to YouTube to scope out a new sponsor, so here’s the intro video I found for Apixio.

I’m losing a handful of sponsors that (a) have hired empowered but industry-clueless marketing people who don’t know what HIStalk is; or (b) are too broke to continue their sponsorship. Contact Lorre to replace them. I don’t lose many sponsors except by acquisition, so it boosts my self-esteem to replace the others.

Webinars

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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

Acquisitions, Funding, Business, and Stock

Vocera announces Q2 results: revenue up 8 percent, adjusted EPS $0.09 vs. $0.02.

Sales

• Carilion Clinic (VA) joins TriNetX’s global health research network to assess its patient population for suitability for clinical trials.

Decisions

• Nemaha Valley Community Hospital (KS) has switched from Medhost to Cerner.
• Essentia Health (MN) is replacing Caduceus Systems with Tecsys supply chain management software, to be completed by June 2019.
• Stonewall Memorial Hospital (TX) will replace Evident (CPSI) with Athenahealth in October 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.

Other

A literature review finds that consumer-facing diagnostic websites and apps – excluding those that are approved or being reviewed by FDA, that perform physical tests, or that offer only literature searches – are poorly supported by clinical studies and sometimes offer low accuracy rates. The categories included symptom checkers, smartphone photo analysis for skin or eyes, and crowdsourced problem solving. The authors recommend that studies name the apps they are reviewing (as they would in medical device studies), consider how the apps work (algorithms versus attached devices), and follow a standardized evaluation methodology.

A data-crunching research project tries to associate EHR adoption with 30-day mortality, predictably failing to conclude much of anything useful for obvious reasons: (a) EHR adoption isn’t binary since use may vary widely; (b) the study used old data from 2008-2013; (c) the authors obviously had no way to prove causation of EHRs to deaths, only to find a faint correlation that is likely to be dependent on a zillion more relevant factors that changed over those years or that differ among hospitals. I want to perform studies that correlate hospital quality to CEO salary, the average Kelly Blue Book value of cars parked in the doctors’ lot, and the number of self-congratulatory awards and signs posted in public areas.

This is dope: A study finds that 25 percent of people who show up in the ED with a sprained ankle were given a prescription for opioids.

CNBC’s Chrissy Farr writes about her sneak peek at Mount Sinai Hospital’s (NY) Lab100, a reinvented, technology-focused annual physical. Patients complete an online assessment in advance, then pass through a series of stations that includes a body composition scanner, a virtual reality-powered strength assessment, and cognition tests, with the results displayed on a screen for discussion with the physician. I’m cynical:

• Are all these tests meaningful, exhaustive, and supported by evidence?
• Do we really need more vague diagnostic measurements that rope people into a medical system they would do well to avoid?
• Is this just another form of the “executive physical” that allows health systems to sell high-margin, medically questionable services that the rest of us can’t afford and probably don’t need?
• Do you go to Mount Sinai because you don’t trust your own doctor who knows you well and who offers — instead of buzzword-heavy gadgetry — medical expertise, empathy, and chronic care?
• Is Mount Sinai doing this to improve population health, the health of wealthy folks who can afford this test, or just its own bottom line, patient funnel, and marketing reputation?
• Do we really need more diagnostic tools when much of our population can’t afford treatments for their known chronic conditions?

Sponsor Updates

• Lightbeam Health Solutions employees donate toiletries and snacks to charities serving the homeless in Dallas.
• MDLive joins Walgreen’s new digital healthcare provider marketplace.
• Waystar will exhibit at the NextGen Texas Regional Client UM August 2 in Irving.
• Netsmart will exhibit at the HCAF Annual Conference July 30 in Orlando.
• Voalte CEO Trey Lauderdale will speak at the Sarasota Young Professionals Group on August 10.
• Mission Health President and CEO Ronald Paulus joins Vocera’s board.

Blog Posts

• The Travails of a Chief Data Officer in a Typical Compliance Environment (Liaison Technologies)
• Nurses Are Already Resilient: What Hospitals Can Do to Help (LiveProcess)
• Not Your Average Fax Machine (Vyne Medical)
• Encryption Isn’t Clinical (Mobile Heartbeat)
• Hospital Costs: A National Solution (National Decision Support Co.)
• Creating a Preferred Post-Acute Partner Network (Netsmart)
• The Quest for Self-Pay Utopia (OnPlanHealth)
• Healthcare runs on revenue (Experian Health)
• Recap: PatientPing Hosts Second New England Community Summit (PatientPing)
• 4 Success Strategies to Free Your Team from Cumbersome Health IT Technology (PatientSafe Solutions)
• Getting it right: 10-point checklist for mobile devices and testing in nursing (PerfectServe)
• What happens when interoperability is solved? (Redox)
• How to Measure the True Success of a Meditech Expanse Implementation (Santa Rosa Consulting)
• 6 Biggest Factors Impacting Your PT Clinic’s Cash Flow (WebPT)
• Patient reported outcomes – what we can learn from our European colleagues (Philips Wellcentive)
• Digital Strategy for the Future of Healthcare Providers (WiserTogether)
• The power of purpose (Wolters Kluwer Health)

Contacts

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

Weekender 7/27/18

Weekly News Recap

• CMS proposes site-neutral payments in which hospital-owned practices won’t earn higher rates for billing as a hospital outpatient department
• Internal IBM documents indicate that Watson Health has made unsafe treatment recommendations
• The White House reverses its decision to halt ACA risk adjustment payments, citing the need to keep small insurers solvent and participating in the exchange markets
• The Department of Defense increases its MHS Genesis budget by $1.1 billion to include implementation of Cerner at the US Coast Guard and to add on items that were included in the VA’s Cerner contract
• The Senate confirms Robert Wilkie as VA secretary
• England’s new Health Secretary Matt Hancock announces $640 million in additional technology funding
• LabCorp continues to restore its systems following a July 13 ransomware attack
• Arizona state records reveal that Banner Health’s poorly managed Epic-to-Cerner conversion at its acquired Tucson facilities caused medical errors and staff frustration

Best Reader Comments

“Healthcare is the only industry that requires its highest-educated, lowest-supply professionals to perform data entry work.” You mean documenting what you do to care for your patients? I can’t think of a single other job where a person doesn’t have to demonstrate, one way or another, that they did their work in order to get a paycheck. (HIT Girl)

So England has gotten over the NPfIT systems implementation failure? At least enough to try something else? (Brian Too)

Maybe its just me, but CMS is completely tone deaf for frontline MDs. This latest salvo of a ‘remedy’ is yet another nightmare. More complex quality reporting, changing the name (AGAIN) to Promoting Interop instead of MU, ACI, etc. Requiring the exact same counting, numerators, denominators, attesting nightmare AND now adding in AUC the CMS answer to pre-auth of MRI CT etc. (Meltoots)

Regarding poll results – thank you for reporting on this even though it is not, strictly speaking, healthcare news. It’s important, both in the realm of politics as well as fly-by-night news stories trumpeting the latest poll results of private companies. Reminds me of the old joke – five out of six surveyed researchers say Russian Roulette is completely safe. (Cosmos)

Re: Epic’s growth is mostly due to its hospital customers acquiring more facilities. While true, one could also argue that their product makes it easier for organizations to consolidate on their platform. (RobLS)

Re: lifestyle information for sale by data brokers. It’s really sad that so many people are so clueless as to how they’re constantly being measured and scored and basically discriminated against. IMO, population health has nothing to do with helping populations, but rather being able to measure and score groups and then drill down to individuals so they can be ‘managed’ for profit. One day there will be a revolt and I suspect it won’t be pretty. (Blocked by Gurus)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Ms. B in Georgia, who asked for tablets, a charging station, and magnetic tiles for her class’s STEAM time. She reports, “It feels like Christmas every time we have new ‘gifts’ brought to our class from DonorsChoose. I am so grateful for supporters like you. You truly understand the struggle that teachers face every day to provide our kids with great education. Technology is so important today and not just for playing video games. Teaching STEAM allows my kids to explore the world in our class. Thank you for being apart of my class and making learning fun.”

Montefiore Medical Center (NY) suspends a radiology resident pending an investigation after an anonymously written, blog-type article claims he is responsible for white nationalist writings that were published under a different name. The website Medium took down the article because it violated its policy against “doxxing” by including his home address, email, phone number, and links to his social media accounts. Netizens predictably took the article as gospel and rushed to judgment to get the “white supremacist doctor” fired after which Montefiore dutifully distanced themselves from him at least temporarily, raising interesting questions: (a) what if the article is wrong?, and if it is, then (b) who pays for his permanently harmed reputation? or, if it’s accurate, then (c) is it OK to fire someone for their off-the-job beliefs or writings, no matter how repugnant they might be?

Investigators execute search warrants to obtain the Fitbit data and social media account logins of a missing 20-year-old University of Iowa student, hoping the FBI can find electronic clues to her disappearance.

The New York Times magazine snarkily rips the fake science, elitist aspirational pretensions, and massive but questionably earned profits of Gwyneth Paltrow’s Goop. A snip:

The weirder Goop went, the more its readers rejoiced. And then, of course, the more Goop was criticized: by mainstream doctors with accusations of pseudoscience, by websites like Slate and Jezebel saying it was no longer ludicrous — no, now it was dangerous. And elsewhere people would wonder how Gwyneth Paltrow could try to solve our problems when her life seemed almost comically problem-free. But every time there was a negative story about her or her company, all that did was bring more people to the site — among them those who had similar kinds of questions and couldn’t find help in mainstream medicine … “I can monetize those eyeballs,” she told the students. Goop had learned to do a special kind of dark art: to corral the vitriol of the internet and the ever-present shall we call it cultural ambivalence about G.P. herself and turn them into cash.

A large-scale study finds that one in six Americans have a past-due healthcare bill on their credit report, 11 percent of them at age 27 after losing the option to remain covered by the health insurance of their parents. Medical debt drops at 45 years of age when 30 percent of people carry health insurance.

Surprise, CA worries about the future of its one-bed hospital that it voted to sell to a 34-year-old private investor from Denver who planned to use it for lab and telemedicine billing from his nutraceutical and lab companies. Beau Gertz hasn’t been around, websites for his businesses have been taken down, four of his former employees say everybody has been laid off, and his office landlord says the space is empty.

Cincinnati’s Shriners Hospital for Children, which treats only pediatric burns, says its future is uncertain since such burns are increasingly uncommon and outpatient treatment reduces the need for inpatient beds.

In Netherlands, the medical complaints board reprimands a doctor who asked the family of a nursing home resident with dementia to hold her down so he could administer a euthanasia IV drip after she refused to drink the sedative-containing coffee that was supposed to have been given first. Dutch law allows anyone over 75 years of age to participate in assisted suicide, but legal questions remain when the person’s mental status is unstable.

An opinion piece written by two doctors says that physicians aren’t experiencing “burnout” (PTSD-like symptoms of exhaustion and cynicism that suggest a failure of resilience) but rather “moral injury,” the lack of ability to deliver high-quality care as trained because of the health system’s patient-marginalizing requirements. They say,

In an increasingly business-oriented and profit-driven health care environment, physicians must consider a multitude of factors other than their patients’ best interests when deciding on treatment. Financial considerations — of hospitals, health care systems, insurers, patients, and sometimes of the physician himself or herself — lead to conflicts of interest. Electronic health records, which distract from patient encounters and fragment care but which are extraordinarily effective at tracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions. The constant specter of litigation drives physicians to over-test, over-read, and over-react to results — at times actively harming patients to avoid lawsuits.

Patient satisfaction scores and provider rating and review sites can give patients more information about choosing a physician, a hospital, or a health care system. But they can also silence physicians from providing necessary but unwelcome advice to patients, and can lead to over-treatment to keep some patients satisfied. Business practices may drive providers to refer patients within their own systems, even knowing that doing so will delay care or that their equipment or staffing is sub-optimal.

Mom-recorded video of a dad dancing to celebrate the discharge of his 15-month-old son from Children’s Hospital of Philadelphia after a 32-day stay for Down syndrome and leukemia lights up the Internet. Says father Kennith Thomas of Merchantville, NJ, “Don’t every look at a situation and think the worst. I want people to look at their situation and flip it and change the perspective.”

In Case You Missed It

• News 7/27/18
• EPtalk by Dr. Jayne 7/26/18
• HIStalk Interviews Jeremy Bikman, CEO, Reaction Data
• News 7/25/18
• Curbside Consult with Dr. Jayne 7/23/18
• HIStalk Interviews Jeremy Pierotti, CEO, Sansoro Health
• Monday Morning Update 7/23/18

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 7/27/18

Startup Raises $100 Million To Allow College, Hospital And Business Bills To Be Paid In Foreign Currency

Financial technology vendor Flywire raises $100 million in a Series D funding round.

CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

CMS’s proposed outpatient reimbursement takes aim at hospitals that have bought physician practices to take advantage of a billing loophole that allows them to immediately raise prices by declaring the practice a hospital outpatient department.

Mon Health Medical Center freeze staff salary, begin improvement plan due to ‘significant financial challenges’

Mon Health Medical Center (WV) freezes employee pay as it begins implementing an operations improvement plan, which includes rolling out a new EHR at its ambulatory facilities.

News 7/27/18

Top News

IBM Watson Health’s supercomputing abilities in the area of cancer treatment once again come under fire as Stat uncovers internal IBM documents showing employee and customer concerns with the software.

“Unsafe and incorrect treatment recommendations” for cancer have been blamed on Watson’s training — by IBM engineers and a team of physicians at Memorial Sloan Kettering Cancer Center (NY) – that used hypothetical instead of real-life cancer cases.

A Jupiter Hospital (FL) doctor complained to IBM, “This product is a piece of s***. We bought it for marketing and with hopes that you would achieve the vision. We can’t use it for most cases.” (the irony being that a hospital that admits buying Watson for its marketing value complains about the company’s overzealous marketing).

A previous Stat report found that IBM started marketing the oncology product before it was ready and without subjecting it to clinical studies, also noting that Watson doesn’t meet the definition of AI since it doesn’t actually learn, it only relays the treatment preferences of MSKCC in what is little more than a virtual consultation. Oncologists also reported that while Watson provides them with background information such as journal articles, it doesn’t directly help them make a decision or tell them anything they don’t already know in regurgitating the hospital’s own training data. It also suffers from lack of clear-cut medical evidence that makes many oncology decisions difficult to turn into algorithms.

MD Anderson Cancer Center (TX) cancelled its Watson partnership in February 2017 also spending three years and $60 million trying to create an oncology advisor similar to the one MSKCC is developing.

IBM Watson Health confirmed in early June that it had laid off an unspecified number of employees, mostly from its expensive acquisitions Truven, Merge Healthcare, and Phytel.

Reader Comments

From A Good Walk Ruined: “Re: Sutter Health. Heard that the Sutter board met Wednesday morning and let CIO Jon Manis go because of its $25 million recent downtime. I’ve also heard that the CFO and COO were let go.” I reached out to Sutter, who confirms that SVP/CIO Jon Manis (photo above), IS Chief Operations Officer Stuart James, and Director of IS Finance Randy Davis have left the organization for unstated reasons. Serving as interim CIO will be Chris Van Pelt, who I believe still works for PricewaterhouseCoopers. Sutter’s Epic and telecommunications systems went down for more than a day in mid-May at its 24 hospitals, which the health system said was due to activation of a data center fire suppression system.

From Careening Corvette: “Re: Medhost. Lists an open position for chief information security officer after having their share of security problems in the past 24 months.” The job sounds like the one William Crank has held, but he still lists it on his LinkedIn.

From Eligible Bachelor: “Re: Recondo. Appears to be buying the former Advisory Board PayNav client base from Optum 360. PayNav was a white label for Recondo products. Terms not disclosed, transition of 57-58 clients beginning immediately.” Unverified.

From Joel Martin: “Re: physicians and EHRs. I spent many years working on Epic optimization, especially for inpatient and ambulatory physicians, and most of the complaints about time and user friendliness are actually about regulatory, financial, and other compliance requirements. Very few of the issues they disliked were actually attributable to the software other than poor defaults for orders. Even note documentation, by far the biggest time spent, is really about a financial decision of the organization to shift cost away from transcription that all EHRs can accept. Individual healthcare organizations and the system as a whole have shifted enormous amounts of work onto physicians over the past 20 years. The EHR enabled a lot of that shift, but is not the cause, and the best EHR possible cannot undo this reality.” I agree with Joel, who’s now with HealthX Ventures– it’s like blaming TurboTax instead of Uncle Sam for the unpleasantness of paying taxes. The worst aspect of the EHR is that it gives non-clinicians a sly way to impose their will on doctors anonymously via software requirements, turning medical documentation into a Pavlov’s Dog experiment in which dollars pop out as a reward for doctors clicking boxes someone wants clicked that don’t necessarily benefit patients and instead steal a big chunk of their allotted encounter time. Healthcare is the only industry that requires its highest-educated, lowest-supply professionals to perform data entry work, keyboarded into submission by executives who wouldn’t be caught dead using a computer while speaking to someone (ever see a CEO’s sumptuous desk hogged by a computer monitor?) I’ve mentioned my $60-per-month all-inclusive concierge PCP, who doesn’t use an EHR and who instead conducts an unhurried, richly nuanced conversation with me, free of the pressure to click, stare at a screen, or wonder if he’ll have his payment denied by a bored insurance company clerk ready to pounce on a mistyped field. The biggest mystery to me is why doctors allowed insurance companies and then hospitals to elbow them out of their own profession and turn them into regularly whipped slaves, or more accurately, why they don’t bolt en masse right now, skim the cash-paying patients, and let the rest of the system crash and burn so we can start over.

Webinars

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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

Acquisitions, Funding, Business, and Stock

Home DNA testing company 23andMe will sell the data of its 5 million customers to pharma giant and just-announced $300 million company investor GlaxoSmithKline for developing new drugs, raising the question of why consumers shouldn’t be paid – even in the form of a rebate — when a for-profit company they’ve paid for services sells their health data to another. 23andMe, which says its consent allows such sharing and requires consumers to opt out otherwise, also acknowledges that it’s doing its own drug development. Meanwhile, Canada’s border patrol is reportedly accessing ancestry websites to determine the nationality of those being considered for deportation.

Atlanta-based billing company Patientco raises $28 million in a Series B round led by investment firm Accel-KKR.

Medical information sharing startup Ciitizen prepares for a private beta program with $3 million from Andreessen Horowitz. Founder and former Apple health technologies director Anil Sethi sold a similar company, Gliimpse, to Apple in 2016.

Up to 1,500 Epic employees begin filing individual overtime claims — some dating back to 2012 – after a Supreme Court ruling that prohibits them from filing as a group. The company settled a similar overtime case with employees in 2014 for $5.4 million.

Google patents headphone technology designed to capture a user’s body temperature and alert them to changes that may indicate the onset of illness.

Financial technology vendor Flywire raises $100 million in a Series D funding round. The company – which offers universities, healthcare organizations, and business the ability to accept online payments in the customer’s own currency – operates OnPlan Health, a full-service patient billing and payment solution for hospitals. 

A Facebook warning about slowing revenue growth sends shares down 20 percent Wednesday, wiping out $120 billion in market capitalization. It’s the largest one-day valuation slide in history for a US-listed company, with the lost market value exceeding the entire valuation of 90 percent of companies in the S&P 500.

People

Lloyd Mangnall (Imaging Advantage) joins AbleTo as SVP of technology.

Healthcare-focused investment banking firm Edgemont Capital Partners hires Kojo Appenteng, MBA (Credit Suisse) as managing director, where he will create the firm’s healthcare information technology investment banking platform.

Announcements and Implementations

Healthcare data science company Apixio launches HCC Auditor, an AI-powered solution that helps health plans and providers perform internal audits of their risk adjustment payment data.

HBI Solutions develops predictive algorithms to help providers identify patients at risk for opioid abuse.

Centura Health (CO) implements health data exchange software from ESO Health to give its 17 emergency departments real-time access to EMS data.

HealthSparq adds timelines and insurance-specific cost estimates for patients who use its HealthSparq One transparency and guidance platform.

Agilon Health will use HMS Essette care management software for its PCP customers.

Sales

• Indiana HIE will deploy Diamater Health’s data interchange, clinical data quality, and e-clinical quality measures products.
• Columbus Regional Healthcare System (NC) selects Avaap to implement its new Cerner CommunityWorks software.
• Hartford HealthCare (CT) will implement data integration and analytics and reporting software from Innovaccer across its 70 ambulatory facilities.
• Flagler Hospital (FL) selects clinical variation management software from Ayasdi.

Government and Politics

CMS’s proposed outpatient reimbursement takes aim at hospitals that have bought physician practices to take advantage of a billing loophole that allows them to immediately raise prices by declaring the practice a hospital outpatient department (a practice closed to new conversions since 2015, but with existing sites grandfathered). The proposed change would mandate site-neutral payments to eliminate that advantage. The American Hospital Association responds quickly in saying that CMS doesn’t understand how hospitals operate.

CMS reverses its decision to suspend the Affordable Care Act’s risk adjustment payments, citing the need to keep payers from becoming insolvent or withdrawing from the market.

Other

An investigation by USA Today into maternal deaths during or just after childbirth reveals a chilling lack of attention to patient safety protocols, resulting in the preventable deaths of 700 women each year. A review of hospital quality records from facilities in New York, Pennsylvania, and North and South Carolina found that less than half of maternity patients were treated for dangerous blood pressure levels; of those that were treated, less than 15 percent received recommended care.

Sponsor Updates

• EPSi employees donate to local food pantries in honor of Global Impact Day for Hunger Relief.
• Medicomp Systems releases a new video, “Enhanced Patient Outcomes with Quippe: Phoenix Children’s CDI Story.”
• Elsevier will offer its STATdx online radiology diagnostic decision support tool through MModal’s Fluency for Imaging speech recognition and workflow management system.
• EClinicalWorks will exhibit at the 2018 FACHC Annual Conference July 29-August 1 in Fort Lauderdale, FL.
• FormFast will exhibit at the FHIMA Annual Convention July 29-August 1 in Orlando.
• The InterSystems IRIS Data Platform is now available in the Google Cloud Platform Marketplace.
• Kyruus will exhibit at the Virtual Health Care Summit July 30-August 1 in Boston.
• AdvancedMD updates its AdvancedInsight financial reporting solution to include enhanced data visualization and cross-browser capabilities.
• Indiana Health Information Exchange continues its collaboration with Diameter Health after successfully piloting the company’s Fusion, Analyze, and Quality applications.
• Optimum Healthcare IT publishes an infographic titled “2018 Health Data Breaches Fast Facts.”
• Meditech Senior Government Affairs Manager Barbara Hobbs joins the HIMSS EHRA Executive Committee.
• Healthfinch makes its Refills Lite e-prescribing solution available to AthenaClinicals end users.
• Audacious Inquiry hires Danny Krifcher (Aledade) as CFO, Marnie Basom (Health Management Systems) as senior director, and Kate Ricker-Kiefert (Amelia Mayme Consulting) as director.
• Parallon Technology Solutions receives the HDI Team Certified Pinnacle of Excellence award for its commitment to customer service.

Blog Posts

• The New Future of Data Automation: What Role Will Alexa Play in Tomorrow’s EHR Integrations? (The HCI Group)
• How to Accurately Troubleshoot Citrix ICA Network and Connectivity Related Issues (Goliath Technologies)
• Digital Patient Engagement and the Connection to Patient Experience (Healthgrades)
• QPP Proposed Rule for 2019: An Overview (Impact Advisors)
• The Duplicate Disconnect (Imprivata)
• How Healthcare Marketers Can Win Over Skeptical Millenials (Influence Health)
• It’s Time to Increase Cybersecurity Efforts (Optimum Healthcare IT)
• EHR upgrades will be on everyone’s mind this August, so let’s talk about it. (Nordic)
• Is CDSS a Life Saver? (InterSystems)
• ATLAS 2018 Breakout Track – Positioning Access as a Strategic Imperative (Kyruus)
• Three Challenges with Managing Physician Offices’ Remote Access to Your Network (Iatric Systems)
• How to use reporting to become a home health top performer (Meditech)
• Bringing a Smart Room to Life: A peek behind the curtain at MUSC’s new children’s hospital (part 2 of 3) (GetWellNetwork)

Contacts

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

EPtalk by Dr. Jayne 7/26/18

The American Medical Informatics Association announces the launch of its Fellowship program (FAMIA)  for recognition of professional achievement and leadership in applied informatics. The FAMIA designation will be inclusive, recognizing physicians, nurses, pharmacists, and others working in the realm of clinical informatics. Fellowship candidates must demonstrate eligibility in education, certification, experience, AMIA membership, and AMIA engagement as well as through peer recommendation and commitment to future activity in clinical informatics.

I’m qualified except for the AMIA “engagement” part. I wonder if being the anonymous face of clinical informatics for thousands of readers would qualify under the “other contribution by petition” category? Applications close September 3 and require a $200 application fee.

New Medicare cards are on the way, with mailings complete in Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia. Patients in those states who haven’t received their cards can sign into www.MyMedicare.gov to confirm the mailing and print a card. I still get questions from practices that are confused about what to do when the new cards start coming in, so make sure your organization has a plan and that it’s well socialized.

Physicians who participated in the 2017 Merit-based Incentive Payment System (MIPS) program are now able to review their CMS-calculated scores and feedback reports. Penalties and incentives based on the data will impact Medicare payments for services rendered in 2019. Providers who have concerns about their performance data can request a targeted review from CMS. Common reasons for review include errors in data submission; physician eligibility issues; problems with the alternative payment model participation list; or issues with previous eligibility.

For a long time, my laptop would give me trouble when I tried to use the camera during conference calls, so I got in the habit of not using it. It’s probably a good thing, since my work-at-home schedule sometimes involved prolonged wearing of pajamas, followed by workout clothes, followed by wet hair. I did get my camera issues resolved and have been trying to make a point of having more of my calls with video.

I’m always worried I will do something dumb because I’ve forgotten that I’m on camera, but I’ve seen enough botched video lately to know that I probably look good by comparison. This week’s highlight reel: a call with someone who immediately got up from the computer and walked away, but insisted he was there reading the materials I was showing; camera angles that gave me a great view of one client’s nasal passage; and my favorite – someone trying to take a call from his boat, resulting in plenty of squinting against the sun and ambient noise from seagulls.

I was glad I wasn’t on camera for one call (the client doesn’t do video, so I don’t feel obligated to do it, either) because I am not sure I could have kept a poker face after hearing this quote from a newly-minted VP of operations: “I assigned this to you because I didn’t know who else to give it to.” I’m betting it didn’t build confidence among his new direct reports, so we’ll be doing some coaching on that approach later.

I was recently asked to provide a reference for a former colleague as she looks for a new position. Her hospital was acquired by a large corporate organization and the entire IT team was cleaned out. She’s applying at one of the only hospitals in our region that is still independent. I was surprised to receive a web link from the hospital, leading me to provide the reference through a short survey. It didn’t appear to really provide a mechanism to provide a peer reference vs. an employer one and gave no opportunity for narrative comment. I was forced to choose “yes” or “no” to a “would you rehire?” question despite not having been her supervisor.

I suspect that the HR department involved is just using these “references” as a check-the-box step rather than using them for actual content. It’s unfortunate, because she was great to work with and I think she would be an asset to anyone, but didn’t have a mechanism to share that information.

My office pre-books their order for flu vaccine as soon as our distributor will take it and requires all employees to receive vaccination as a condition of employment. Since we’re just about six weeks out from the start of the vaccination season, I was glad to see that the CDC’s Advisory Committee on Immunization Practices (ACIP) has included nasal flu vaccine in this year’s recommendations. There are quite a few people who are reluctant to have a shot but will accept the risk of a live (although modified) vaccine up their nose.

Last year’s flu season was particularly gruesome, and I hope we have an easier time this season. ACIP also delivered new guidelines on anthrax vaccine for post-exposure prophylaxis and updated recommendations on HPV, mumps, zoster, and pneumococcal vaccines. EHR vendors, start your engines – it’s time to update your logic. EHR clients should make sure they’re taking updates so that they have the best information available in their systems. I would estimate that more than half of the clients I work with don’t take regular updates to their systems unless they’re automatically applied in the background.

I was hanging out on a conference call the other day, waiting to figure out whether my client was just late or was going to no-show. I came across this site offering lab coats “for the perfect poise” that will ensure that “customers are enabled with confidence and grace through its sophisticated but classy appearance.” They ought to be pretty enabling since they start at $178 and run to $340. I found several other sites with pricey coats, and although they were more stylish than what I usually buy, given the things that are occasionally splashed on us at the office, I think I’ll stick with my $25 version.

I’m not sure whether it was worse for him to no-show or to have to endure the call I was on next, which featured an attendee who was doing the “I’m on two calls at once” routine but had the other call on speaker so that everyone else could hear it. Unfortunately I wasn’t the host and my client thought it was OK, so I was forced to play along. I still struggle to understand how someone can think they are able to meaningfully participate in two calls.

Given challenges in staffing and an overall nursing shortage, one hospital has come up with an innovative solution for staff retention. Pediatric nurses at Mercy Children’s Hospital can opt for a “seasonal staffing” program that allows them to work nine months out of the year but maintain their full-time benefits while taking summers off. The move addresses low census issues during the summer while expanding time off to travel or care for children out of school for the summer. Hospital leaders also hope it will allow nurses to recharge and return to work with “excitement for nursing.”

Having grown up as the child of a teacher, there’s something to be said for being able to have family adventures when school is out for the summer, even if there’s a chance your mom might want to leave you at a scenic overlook because you’re a grumpy pre-teen.

What’s your favorite childhood vacation memory? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/26/18

IBM’s Watson supercomputer recommended ‘unsafe and incorrect’ cancer treatments, internal documents show

Internal IBM documents reveal that Watson Health employees and customers identified “multiple examples of unsafe and incorrect treatment recommendations” as the company promoted the software to prospects.

Some Epic workers will continue to fight for overtime pay as individuals

Epic employees working in quality assurance and tech writing begin filing individual overtime claims after the Supreme Court ruled they cannot file them as a group.

Patientco Primed to Help More Health Systems Rethink Patient Payments with Strategic Growth Investment Led by Accel-KKR

Patient billing company Patientco raises $28 million in a Series B round.

Trump Administration, in Reversal, Will Resume Risk Payments to Health Insurers

The White House reverses its decision to suspend the Affordable Care Act’s risk adjustment payments, citing the need to keep payers from becoming insolvent or withdrawing from the market.

HIStalk Interviews Jeremy Bikman, CEO, Reaction Data

Jeremy Bikman is CEO of Reaction Data of American Fork, UT.

Tell me about yourself and the company.

I’ve spent a long time in healthcare doing research and helping hospitals, clinics, and even the vendor side make better decisions. That’s what our company does. We get organizations, whether they’re a hospital or vendor, answers to their biggest problems really quickly.

What are the most-hyped and most-promising healthcare technologies?

Over-hyped is blockchain, hands down. People don’t even know what it is. It’s moving so fast. You would think that in an industry like healthcare, people would be more skeptical because we’re supposedly a more data-driven, evidence-based industry. You go to HIMSS and someone says they’re doing something with blockchain. You ask them to describe its advantages and they end up talking about the technological benefits. You ask what that means for a hospital and they can’t articulate it. How is it going to improve the bottom line, top line, patient care, whatever it is? They’ll answer it as a feature statement rather than benefit.

Most promising is, surprisingly, artificial intelligence. I say “surprisingly” because healthcare is typically last to the tech adoption game on anything that’s emerging. But we’re seeing that it’s picking up the pace pretty significantly, mainly in the imaging departments, but also expanding outside.

We launched some research around that. We wanted to keep it open ended, asking the C-suite where they saw it being used without giving them a list to choose from. Number one was virtual health services. It’s interesting that they said that since CMS just said that they will materially up the reimbursement level for telehealth, telemedicine, or I guess I’ll use the macro term virtual health. That correlates to what the hospital C-levels are saying, that AI will be the most disruptive, impactful, and beneficial emerging technology.

Second is machine learning and deep learning. I was surprised that CEOs of hospitals said that. We get skeptical when someone makes a choice like this, so we asked, you said machine learning, do you even know what you’re talking about? They really did. They could talk about it, saying, we have all this data, and if we could use machine learning algorithms to look at it, maybe it could help us predict the types of patients who are most likely to miss an appointment or not take a med. These algorithms could help us with medication adherence, following a certain protocol, or even with logistical issues.

On the imaging side, it was much easier for them to answer that it could help a radiologist diagnose something or notice some lesion or some problem with a vessel within an image much more quickly. That would make them more efficient and hopefully raise the clinical efficacy of the encounter and the diagnosis.

Then they brought up the nebulous interoperability, which they couldn’t describe it at all. Most of the research I’ve seen around interoperability is pretty garbage. Everybody defines it in their own way, and if they can define it their own way, then we don’t have a definition. I don’t know how you attack a problem that has a nebulous definition.

Wall Street and private equity firms are buying high-income medical practices such as dermatology and are already deep into hospitalist, ED, and anesthesia staffing. How will that change the market?

It will be interesting to see if pay-for-performance ever really takes off or some mandate from on high alters the financial dynamic whether they’ll really stay in. Do they go the way of a lot of these vendors that come in and do the hokey pokey, where their right foot’s in, their right foot’s out? You never know. That’s why a lot of healthcare organizations are professionally skeptical. They’ve learned to be about those new entrants that say they know healthcare or that buy their way in.

People buy up amazing companies and do layoffs right away. You talk to those acquired installed bases over a few years and they say, it’s all changed. Things were going really well before. I understand economy of scale, but the problem is when that they get integrated, it goes in the opposite direction. Things are getting worse. They might be getting some sort of year-over-year benefit from economies of scale, but the end users don’t.

You’re seeing the same thing with Wall Street, private equity, and others jumping in. There’s money right now and there’s inefficiency. But once they’ve squeezed as much inefficiency out as possible, then they start looking at their returns. They owe their limited partners or their investors. That’s who they serve. How long will they stay in the game? Are they in it for the long haul? I doubt it. Some are, so they will be able to make some improvements and then look at it as a long-term play.

You’ll see a lot of them getting out in the next decade or less. You can see these guys having to go private again or coming up with their own ownership groups or whatever it is. You’ll see the investors stepping out. That’s again if the government doesn’t step in, behind the scenes, and collude to help make markets happen, keep people in business, and keep themselves elected. I’m going to get really cynical if we get into the government aspect. Which I’ll certainly do, and I’m willing to fall on my sword about my opinion of government and business collusion. But enough about the HITECH Act.

What changes have you seen in the big four inpatient EHR vendors of Epic, Cerner, Meditech, and Allscripts?

Hospitals and clinics have learned that an EHR is not the panacea it was made out to be, or I should say, it was mandated to be. It certainly needed to happen, but whether it needed to happen as fast and in such a rigid way is up for debate.

\What they’re finding out is that, we put the EHR in because we were explicitly or implicitly promised that we would see a lot of improvement. Patient care would improve, and over time, our organization’s financial position would improve, all because of digitizing patient records, order entry, the MAR, and everything else. What you’ve seen — at least from the research I’ve done and research I’ve read – is that there has not been a material or even statistically significant improvement in hospital bottom lines, clinic bottom lines, or patient outcomes.

Now what are they doing? We have to create accountable care organizations. We have to coordinate patients. We have to get them in their own little sub-populations. How do we treat those patients? We had better have analytics. Do we even have a real data warehouse? Crap, now we have to go get a real data warehouse. Now we have all the data, we don’t know how to analyze it, so we had better get several analysis tools. Do we know how to do that? No, so we have to hire Accenture or Deloitte or some other firm to come in and help out.

They start realizing that for all the time and money they spent on an EHR, all they have done is that the ball got kicked into the end zone and it’s been advanced to the 20-yard line. You mean that we have 80 yards more to go? Yes. Now they’re having to look at everything else to understand that the EHR, these big clinical systems, get put in and they’re the operating system of the hospital. You have a lot more apps and a lot more things that you have to load on top of it.

That’s not the way it was sold back then. Ten years ago or so, no one was talking about having do do all these sorts of things and I’m not sure everybody knew it. When you’re a hospital trying to run your organization in dealing with state mandates, local mandates, employers, payers, and Medicare, it’s tough. You have to rely on the vendors you work with to help you out. You really do. I’m not sure the vendors really understood that it’s not just putting in the EHR. I don’t think anyone would have bought it if they realized, we’re going to spend how much of our budget? Then the upgrades are going to be all this and other sorts of stuff? That’s just the foundation now. We have to do all these other things and bear all this additional cost and labor.

It’s shocking that so much money has been spent on the space, our space. What are the outcomes? Are hospitals in better financial shape? Has putting in all this technology caused a significant improvement in outcomes — financial, operational, specifically for patients? No. You certainly had to put in these systems, but the end result has not been as super positive as everybody expected. I don’t think anyone was necessarily to blame. I don’t think Epic, Cerner, Meditech, or Allscripts went in knowing, ha, you’re going to have to dump huge amounts of money here and then load all these other solutions over time. Because I don’t think people anticipated it. We have so much more that we have to do. I really see healthcare at about the 20 or 25-yard line.

Looking back at the HIMSS conference, how are vendors approaching the market?

It’s net fishing, where you’re just throwing out instead of being precise. They’re just trying to catch it all. So many vendors say they can do pretty much everything. If you look at the HIMSS listings for vendors, you know some of them really do just one or two things, but they will list 15 or 20 because they’re just trying to catch attention.

HIMSS is something you have to do, but I’m wondering about the value of what’s going on there. I love it because you get to collaborate with everyone. That’s the best part of it. People come by our booth just to hang out, ride our bikes, and try to break a clavicle or something. They just come to talk. Most of them just shake their head because everybody does everything and it’s all becoming white noise. It’s hard to differentiate.

My recommendation to vendors is to know who you are, know your ideal customer who you can have the greatest success with, and try to be precise in your messaging to that group. Because everyone’s getting washed out. That means that only the largest of the large are going to get attention because of their sheer scale, size, and reach.

Being precise is better for attendees and eventually better for vendors. You may not get as many people coming by your booth, but you’ll get a better quality of interaction and probably end up closing more business. But taking that approach is a scary step into the dark, because everybody is saying they do lots of things and trying to get more people to come in. That confuses the message and prolongs the sale.

The most successful vendor at HIMSS seems to be HIMSS.

They bought Healthbox, which invests in tech companies. HIMSS is indirectly and directly competing with almost every one of their members. It’s confusing. They’ve done a brilliant job.

You wrote some funny stuff about the HLTH conference. That would not have emerged if everyone was happy about what’s going on with HIMSS. There is demand because HIMSS is this incredibly successful organization that seems like it has to grow. It doesn’t know how to stay put, so it has to acquire other conferences, do partnerships, and acquire a research company or whatever HIMSS Analytics is now. I heard many vendors say they’re not really comfortable now because HIMSS was a partner — an expensive partner, but a partner — that offered value, but now it’s encroaching into their business.

Do you have any final thoughts?

Disruption is the name of the game, far more than ever. I don’t necessarily mean technology disruption, it’s more organizational. The lines are blurring and they’re going to blur even more to where entities become indistinguishable from one another. You’re seeing hospitals launching vendors. You’re seeing vendors looking at coming up with their own healthcare organizations. You’re seeing insurance companies do different intermediaries, buying up provider organizations all over the place.

We just did research around the frustrations that physicians and nurses are dealing with. We looked at key disrupter stuff, such as Amazon or others coming in, and what hospitals and clinics plan to do about it. We found out that 48 percent of healthcare organizations have active plans to acquire other healthcare orgs, get acquired, or do a merger in the next few years, which is enormous. The level of disruption we’re seeing just within provider M&A is enormous.

I would not be surprised if you start seeing massive investments in the life sciences and drug companies into provider organizations to help shrink clinical trials and to get more access to that information. You’ve seen what Intermountain is doing. We did a huge amount of research around the generic drug company they are launching. That never happened before. That’s a seismic event. I don’t think the drug companies are going to sit back and go, OK, fine, whatever. This is a signaling of all the lines blurring and everything coming together.

It’s almost like the old company store model, where the town is owned by the company that puts up the road, hires the police force, and runs the stores. I’m going to go on record as saying that you’ll have a single entity that is a drug company, a provider org, a vendor, and a payer. You’re seeing it coming together and it’s crazy. It could be awesome crazy or it could be really bad crazy, but as we’ve triangulated all of the enormous amounts of data that we’re collecting, it’s heading that direction. I don’t know when that will happen, but it will be super fun to watch.

Morning Headlines 7/25/18

Pentagon to Increase Health Records Contract Ceiling By Another Billion

The Department of Defense will increase its EHR contract ceiling by $1.1 billion in expanding MHS Genesis to cover implementation of Cerner by the Coast Guard.

Identity Automation Announces Acquisition of HealthCast Inc.

Identity and access management technology vendor Identity Automation acquires HealthCast, which offers single sign-on and virtual desktop systems for healthcare.

Making healthcare better for everyone—including providers

Google Cloud announces that former Cleveland Clinic President and CEO Toby Cosgrove, MD has signed on as an advisor to its healthcare and life sciences team.

Scoop: 23andMe is raising up to $300M

23andMe prepares for the sale of up to $300 million in new shares, potentially driving up its value to $2.5 billion.

News 7/25/18

Top News

The Department of Defense will increase its EHR contract ceiling by $1.1 billion in expanding MHS Genesis to cover implementation of Cerner by the Coast Guard. The extra cost will also cover items included in the VA’s contract that were not present in the DoD’s agreement, according to Defense Healthcare Management Systems Program Executive Officer Stacy Cummings.

Cummings added, “A standard electronic health record baseline for the Department of Defense, Department of Veterans Affairs, and US Coast Guard will enable more efficient, highly reliable, safe, and quality care.”

The DoD’s original contract ceiling with lead contractor Leidos was valued at $4.3 billion and a total of $9 billion if all options were exercised.

The Coast Guard gave up on its attempt to implement Epic in 2015 after running $46 million over budget with no sites live. A GAO investigation blamed poor project management, insufficient governance, inadequate project documentation, lack of testing, and internal staff turnover. The Coast Guard began searching for an alternative to Epic in February 2016, reverting to paper and, according to the GAO, endangering members with convoluted processes.

Cummings said the Pentagon will publish a second evaluation report by the end of the year, following a scathing internal review from May that concluded that MHS Genesis “is neither operationally effective or operationally suitable” and not capable of managing care delivery.

The DoD also announced that the next four MHS Genesis rollout locations will be Naval Air Station Lemoore, Travis Air Force Base, US Army Health Clinic Presidio of Monterey, and Mountain Home Air Force Base.

Reader Comments

From FlyOnTheWall: “Re: Allscripts. The company’s investor page proudly boasts in a press release from last year that Rothman Ortho selected Allscripts PM to replace its ‘legacy system.’ Was not that system Allscripts Vision? Nice to see Allscripts getting into the rip-and-replace frenzy of Allscripts solutions, even though they did an RnR of one of their own products.” Unverified, but I believe Rothman was using the old Vision product of Medic / Misys, acquired by Allscripts in 2008. If that’s indeed the case, then I would categorize the announcement as misleading since it’s just swapping one Allscripts product for another, not a brag-worthy displacement of a competitor’s system.

Webinars

July 26 (Thursday) 1:00 ET. “The Patient’s Power in Improving Health and Care.” Sponsor: Health Catalyst. Presenter: Maureen Bisognano, president emerita and senior fellow, Institute for Healthcare Improvement. Patients, even those with chronic diseases, only spend a few hours each year with a doctor or a nurse, while they spend thousands of hours making personal choices around eating, exercise, and other activities that impact their health. How can we get patients to be more engaged in their care, and help physicians, nurses, and healthcare providers transition from a paradigm of “what’s the matter” to “what matters to you?” This webinar will present stories of patients and healthcare organizations that are partnering together with tools, processes, data, and systems of accountability to move from dis-ease to health-ease.

July 31 (Tuesday) 12:30 ET. “How to Proactively Troubleshoot End User Experience Issues in Healthcare IT.” Sponsor: Goliath Technologies. Presenter: Goliath Technologies engineering staff. An early warning system for EHR access problems helps prevent downtime and user access problems before they impacts patients and collects objective technical evidence of the issue’s root cause. This webinar will describe how hospitals protect their investment in Allscripts, Cerner, Epic, and Meditech EHRs by anticipating, troubleshooting, and preventing end user experience issues and collecting the technical data needed to collaborate with their vendors on a solution.

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

Acquisitions, Funding, Business, and Stock

Identity and access management technology vendor Identity Automation acquires HealthCast, which offers single sign-on and virtual desktop systems for healthcare.

Former employees of the shuttered CareSync describe the company’s final days to the Hardee County (FL) Board of County Commissioners, saying they were pressured to keep patients of its chronic care management business on the telephone line for at least 20 minutes to qualify them for their monthly Medicare billing. CareSync co-founder and State Rep. Jamie Grant — who served as senior solutions architect and was cleared of ethics violations after charges that he funded the company’s startup by misusing Hardee County development grants – says he hasn’t ruled out suing unnamed parties. Co-founder Travis Bond, who employees said was removed by the board because of poor financial management, says he does not plan to pursue litigation.

Cerner has added half of the 600 Kansas City-based employees it needs for an expansion of its RevWorks and ITWorks outsourcing businesses.

University of Minnesota hopes to license an algorithm created by its medical school researchers that predicts a patient’s one-year mortality risk using EHR data.

People

DirectTrust hires Scott Stuewe (DataFile Technologies) as president and CEO. He worked for Cerner for 20 years through December 2016.

Methodist Health System (NE) promotes Kent Sona to VP/CIO.

Announcements and Implementations

A Reaction Data survey of 250 physicians finds that EHRs, regulatory compliance, and internal bureaucracy contribute most to their burnout, with patients named as the problem only 2 percent of the time. The top wished-for EHR improvements are improved user friendliness, additional dictation or scribe capabilities, and reduced time required.

A Black Book survey finds that two-thirds of hospitals are reconsidering whether the ED information system supplied by their EHR vendor can handle efficient ED workflows and meet consumer expectations, with outsourced ED doctors being the least satisfied due to EHR training gaps, excessive clicking, and difficulty in obtaining outside patient data. ED doctors who were forced to move from a best-of-breed EDIS to an EHR’s ED module say their new system hurts their productivity (90 percent), impedes patient workflows (75 percent), and contributes to medical staff burnout (90 percent). CIOs are mostly at odds with those beliefs, favoring a single source EHR solution. The top-rated best-of-breed EDIS vendor is T-System, followed by Optum Picis and Wellsoft. Cerner, Meditech, and Allscripts were also highly rated by users. The most-desired features of both types of EDIS in order are better mobile deployment, interoperability, and patient satisfaction tools.

Government and Politics

The Senate confirms Robert Wilkie as VA secretary in a 86-9 vote.

The National Institutes of Health launches its Google Cloud-powered STRIDES Initiative to allow researchers to analyze large biomedical data sets. Meanwhile, a Google Cloud blog post says that former Cleveland Clinic President and CEO Toby Cosgrove, MD has signed on as an advisor.

Privacy and Security

A Kaiser Health News report recommends that consumers pay cash for alcohol and cigarettes while bragging about gym memberships on social media since insurers and other groups are using personal information from credit cards and other sources to create individual profiles that are then sold to companies. Buyers include drug manufacturers – which might want to buy a list of men over 50 who are experiencing erectile dysfunction – and insurers that may use the profile to predict lifespan or medication adherence. Even employers can use the information to check for a job candidate’s potential work-affecting and expensive chronic illnesses before hiring them. The article quotes Harvard fellow Adam Tanner, who wrote “Our Bodies, Our Date: How Companies Make Billions Selling Our Medical Records.”

Other

A small JAMA-published study finds that back-end speech recognition (specifically Nuance’s former EScription product) has a 7 percent error rate when creating dictated notes (operative notes, office notes, and discharge summaries), with some of those errors such as “grown mass” instead of “groin mass” remaining on the chart for weeks or sometimes indefinitely as clinicians either don’t review them promptly or sign them without double checking. The authors recommend that speech recognition errors be submitted for calculating error rates and for creating automated error detection systems.

Banner Health posts a job for CEO of its Tucson campuses just after its corporate VP/CIO announced plans to leave and the local paper published documents from a state investigation into problems with patient care, provider satisfaction, and billing from its Epic-to-Cerner conversion at the former University of Arizona Health Network hospitals in Tucson.

Google’s Nest home automation division is approaching eldercare facilities to use its products for monitoring the wellbeing of residents.

A Stanford University scientist invents a patch that measures cortisol in sweat to detect disease, measure stress, and evaluate sports performance.

Columbia University’s new Center for Precision Dental Medicine offers RFID tracking of patients and equipment, biofeedback-measured stress levels for quantifying pain, video recording of procedures, and all-digital dental chairs whose six instruments are RFID-enabled for tracking usage and sterilization. They hope to use the resulting data not only to make patients more comfortable, but to analyze provider technique to identify best practices. They also hope to to integrate their systems with EHRs to remove the silos between professions.

Sponsor Updates

• Ellkay will exhibit at AACC’s Annual Scientific Meeting & Clinical Lab Expo next week in Chicago.
• Iatric Systems will exhibit at the SHIEC Annual Conference August 19-22.
• In Ohio, the MetroHealth System and Medical Mutual become the first provider and payer organizations to digitally exchange data and documents with Hyland’s OnBase Mackinac solution.
• AdvancedMD publishes a new eGuide, “Best Practices to Improve Patient Payments.”
• Nordic posts a podcast titled “Developing a strategy for your Epic Community Connect program.”
• Audacious Inquiry names Roxanne Johanning health IT product manager.
• Arcadia will host a career open house at its Pittsburgh office July 25.
• CompuGroup Medical will exhibit at AACC July 29-August 2 in Chicago.
• Divurgent publishes a new white paper, “Medjacking: A Life or Death Issue for Leaders in Connected Healthcare.”

Blog Posts

• Is Your Practice HIPAA Compliant? (ChartLogic)
• How to Deliver On-Time, On-Budget, and On-Value Health IT Projects (Spok)
• Enhancing the Hospital Experience: Building a smart patient room (part 1 of 3) (GetWellNetwork)
• Have a new hire? This is the first meeting you should schedule. (Advisory Board)
• What can radiology learn from the hotel industry? A lot, apparently (Agfa Healthcare)
• 5 ways to transform ambulatory workflow (Bluetree)
• Is Your Practice HIPAA Compliant? (ChartLogic)
• A ‘Women in HIT’ Partner: Paving the Way for Better Patient Care (CoverMyMeds)
• CTG Exec: Managing Data Vital During Health Care Mergers (CTG)
• Effective Clinical Data Normalization Multiply Use Cases for Clinical Data (Diameter Health)
• Overcoming Data Zombies with Analytics (Dimensional Insight)
• How Urgent Care Startups Can Compete in the Land of Giants (DocuTap)

Contacts

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

Morning Headlines 7/24/18

Senate Confirms Pentagon Official To Head Veterans Affairs Department

The Senate confirms Robert Wilkie as VA secretary in a vote of 86 to 9.

Cerner adds 100 more employees on its way to hiring 600 in KC

Cerner fills half of the 600 positions it announced it would staff as part of its new CernerWorks managed services business.

Theranos Investors, Founder Holmes Resolve Shareholder Suit

Theranos founder Elizabeth Holmes settles a 2016 lawsuit brought by disgruntled shareholders who had indirectly invested in the company through investment funds.

Curbside Consult with Dr. Jayne 7/23/18

Every time CMS releases new proposed rules, I feel like the circus has come to town. The most recent offering includes 1,472 pages of bliss and is open for public comment until September 10.

I used to try to read them on my own, but found it too hard to get through them in a timely manner. I’m grateful to the people who have dedicated time to review and summarize them for the rest of us. It seems like most healthcare media outlets are trumpeting the “historic shift” for ambulatory Evaluation & Management (E&M) codes, so I decided to do a little deeper dive myself. Most recent federal proposals trumpet their aim to reduce administrative burdens, so I was curious whether they had truly found the “easy” button.

This document is a double whammy, addressing both the Medicare Physician Fee Schedule and the MACRA Quality Payment Program. There’s a whopping 0.13 percent increase in the fee schedule, which frankly I would rather have had them just keep it static than to try to explain various updates and adjustments. There are new G codes for preventive telehealth services that may be enticing for primary care physicians.

Our enthusiasm is curbed, though, by the continued insistence on EHR support for Appropriate Use Criteria for Advanced Diagnostic Imaging. That’s a measure that has been created, delayed, stayed, and revisited for the last several years and now will start in January 2020, with a year-long testing period but no enforcement. Providers can apply for hardship exceptions if they have poor Internet access, EHR vendor issues, or uncontrollable circumstances. CMS is relaxing a bit in allowing AUC tasks to be performed by ancillary personnel rather than requiring the provider to do the work, so that’s a good thing. It will be interesting to see how much of a difference the use of AUC really makes. In my market, we’re already well trained by commercial payers so that we don’t order tests that aren’t indicated.

The Accountable Care Organization programs received an update, with some measures being retired and a new one added. I didn’t spend too much time on the ACO part of the rule, since it’s expected that CMS will release a separate ACO regulation in the near future. I jumped to the part about outpatient E&M coding, which wasn’t as exciting as I expected. Providers will have the choice to document and code their visits based on the current schemes (formulated in 1995 and 1997) or through either a framework around time and medical necessity, or one around medical decision making. Rather than the distinct charges we have now for visits under the 99202-99205 and 99212-99215 codes, a blended rate is proposed.

Not surprisingly, there is a shift towards the lower end of the range rather than a shift towards the higher end, and for those of us used to performing and documenting high-level visits, it will be a cut. This may be made up for by the reduced documentation requirements, but for providers used to maximizing their use of macros, personal defaults, and templates, the perceived reduction in work isn’t going to make up for a more than 10 percent reduction in payments. If you’re not optimized on your EHR or don’t document efficiently, it may be a boon, but not for every practice.

As far as MACRA, MIPS, and the Quality Payment Program, CMS is just shuffling things around again. Advancing Care Information has been renamed Promoting Interoperability, and additional providers are being invited to the party: physical therapists, occupational therapists, clinical social workers, and clinical psychologists. From a quality perspective, all-cause readmission is being added as a measure for groups. Quality reporting will remain full-year, despite provider groups lobbying for a change.

Quality measures that CMS has identified as ineffective will be dropped, potentially saving physicians $2.3 million. Additional quality measures will be added, including four that address patient-reported outcomes. Reporting for Improvement Activities will be 90 days, however, along with Promoting Interoperability. Use of Certified EHR Technology that complies with the 2015 edition is mandatory. Within the Promoting Interoperability category, new elements are available for Prescription Drug Monitoring Program (PDMP) query, verification of an opioid treatment agreement, and expansion of electronic referral loops by receiving and incorporating information. Vendors will need to incorporate functionality to track and report on these elements, and I suspect that many do not currently have that capability.

Security Risk Analysis remains a required element. I continue to find practices that think that this is somehow the responsibility of their EHR vendor and who don’t understand that it’s the covered entity’s responsibility, with EHR vendor compliance being only one piece of it. Organizations are required to assess how they handle Protected Health Information in a variety of different settings, whether in person, on paper, on the phone, etc. which may or may not have anything to do with the EHR. If you don’t know your organization’s plan for Security Risk Analysis, it might be worth a discussion.

As was true previously, participation in an Advanced Alternate Payment Model such as an Accountable Care Organization means a practice doesn’t have to keep track of all the changes in the Merit-based Incentive Payment System (MIPS) model. The APM track is definitely where CMS wants providers to be, adding a 5 percent bonus for them. CMS is also pushing providers to be ready for programmatic updates on a regular timetable with its move to combine QPP with the Physician Fee Schedule. If this holds, providers can plan for updates to both in July and November instead of playing the waiting game.

Still, each time a new rule or proposed rule comes out, the chatter in the physician lounge increases. In my market, we’ve seen a number of established clinicians opt out of Medicare and even more choose to move to cash-based practices whether they involve retainer / concierge fees or not.

My practice remains firmly opted out of MIPS although we accept Medicare patients without restrictions. It remains to be seen whether there will come a time that the penalties outweigh the extra work that will be required to avoid them. So far, we’re diversified enough that it’s not an issue. As I work with practices that don’t have the luxury of non-participation, I’m thankful for that day a couple of years ago when we disabled the “Meaningful Use Content” checkbox and our lives got quite a bit easier.

Given the published comment period on this proposed rule and the typical CMS schedule, we’ll know in a couple of months whether any parts and pieces will be thrown out or modified. Based on this proposal compared to all the feedback that has been submitted on other proposed rules, I’d bet there aren’t too many material changes.

What is your take on the proposed rule for MPFS and QPP? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jeremy Pierotti, CEO, Sansoro Health

Jeremy Pierotti is co-founder and CEO of Sansoro Health of Minneapolis, MN.

Tell me about yourself and the company.

I grew up in Madison, Wisconsin. I went to school out East, then worked in healthcare policy in Washington, DC after college. I then moved to Minnesota for graduate school. Despite promising my wife that we would be here for only two years, that was 1996, and we’ve been here in Minnesota for 22 years.

We started the company in 2014. We knew that the next generation of digital health solutions would require data liquidity. We thought we had an innovative way of providing advanced data exchange between health IT applications. I had no actual skills since I’m not a physician and I can’t code, so when I showed my partners how to move a PowerPoint slide backwards and forwards, they told me I should be CEO.

How widely are APIs being used in healthcare?

We’re seeing them adopted at an accelerating pace. We’re excited by it. I’ve always believed that in healthcare, we adopt treatment technology eagerly and deploy it pretty rapidly. New information technology has been adopted more slowly. But now we are counting on digital health solutions to help us deliver better outcomes with lower costs, higher patient satisfaction, and higher provider satisfaction. Recognition is now widespread that this will happen only with secure, seamless exchange of data between applications. In manufacturing, retail, logistics, and financial services, that’s all done through APIs. We are seeing more rapid adoption of that in healthcare, too.

Do EHR vendors make it easy for customers to integrate their products with those sold by other companies?

To some extent, yes. Most of the major EHR platforms have API or developer programs. Some are more robust than others. It depends on the business strategy of the company and the other demands that are on the company. A lot of regulatory requirements have been placed on EHR vendors over the last 10 years. That has consumed a lot of engineering and product development time within those teams.

Our goal at Sansoro is to provide a universal API so that great developers and great healthcare software companies can write to a single API standard. Then we will handle the nuances of getting the data out and putting the data back into the EMR. As a developer, you don’t have to learn the different APIs and the different integration approaches of each vendor.

I saw you your site that Emissary doesn’t update EHR tables by scripted inserts or updates, but instead uses the vendor’s back-end service to preserve their validation logic. What are the use cases for updating the EHR database and do other methods do direct database updates?

I don’t know whether other companies are doing direct table inserts. Our team is a collection of experienced health IT personnel who know how to create safe application. We’ve all been working with health IT for 20, or 30 years per person. Our approach has been to use the back-end services to make it a safer process. We also get to take advantage of the work that’s already been done by the EHR vendor in terms of the updates.

Examples of what we allow for writing data to the EHR would be discrete observations, documents, and notes. Pretty straightforward stuff, but important. In most provider systems, the EHR is the system of record, so it’s important to get key data into the EHR itself. That’s the operating system for a provider.

Our secret sauce is doing the hard work of mapping the data structures of all of the different EHRs that we support into a unified data model. That’s the holy grail. That’s why we can provide a single API in which an engineer can read data from different vendor platforms and write data back to different vendor platforms without having to know the nuances and differences between those vendor platforms.

What are the most-request API integrations and also the most-desired that aren’t yet available?

We see three common use cases across our customers and prospects.

One is pretty simple. We want to pull patient charts. We typically will have to do an extract, run a database report, or send personnel into the clinic or hospital to print out the chart or print it to a PDF. Being able to pull that chart for quality reviews, medical necessity reviews, and release of information — just being able to pull the basic patient chart — is a standard need and use for our APIs.

The second is for advanced analytics. Basic patient chart information, but with additional information. What clinic or department was this patient in when this procedure was performed? What is the provider’s background? Then combine historical information with real-time information to create a dashboard back to the provider in real time, with insight about the possible best treatment for this patient or how the patient’s condition is improving or deteriorating. Real-time analytics, pulling both historical data and data that’s up to the minute from the EHR or from other data sources to provide those exciting insights for clinicians for administrators.

The third and broadest use case involves workflow improvement. Probably 200,000 prior authorizations are submitted every day in the United States. You print out a bunch of information from the patient’s chart, fill out a prior authorization cover sheet by hand, and fax it into the payer. Then the payer has a person who adjudicates that prior authorization. Often, the the approval will be snail-mailed back to the provider. Not really up to 21st century speeds.

Workflow improvement is using our integration platform to listen for orders, determine if those orders require a prior authorization based on the patient’s insurance, and if so, grab only the data that’s needed from the chart to adjudicate that prior authorization, and then push the approval number back into the patient’s chart. All without any further human intervention. Once the provider places the order in the EHR, the rest happens automatically. That’s a great workflow improvement that saves hours for every prior authorization request.

Another great workflow improvement involves unified communications. Lots of companies provide communications tools that augment the EHR tools, whether it’s Vocera, Voalte, PatientSafe Solutions, or Spok. There’s a pretty good list of vendors that have great tool sets. Enhancing those tool sets to send those messages to the right clinician with appropriate context. Here’s a lab result for the stat order you placed, but in addition to this lab result, we’re going to include the last three results for that same lab test so you can put this result in context. Also, here are the patient’s most recent vital signs and here’s the medication list.

As a provider, you’re not getting a call from the lab with the lab result and then having to log into the EHR to find all that information manually. Instead, it’s delivered to you on your smartphone. As a clinician, that saves you a lot of time and allows you to make a decision faster about the appropriate treatment for that patient.

The FHIR standard is even further entrenched now that Apple is using it to populate Health Records. How does FHIR fit into the overall needs for interoperability?

We believe in a “FHIR and more” approach. Our integration platform, we believe, provides the most complete and comprehensive integration on the market today. But we understand that there’s a role for FHIR.

The challenge with any standards group is that it takes time to develop those standards, and that’s totally understandable. The other thing we’ve seen is that those standards are a paper-based or an electronic specification, but they don’t always get implemented in the same way by each vendor. You can look for a single FHIR resource and find that different vendors implemented it in different ways. You would need a different code base for using the same FHIR resource from one vendor to another.

We believe that FHIR has an important role and Apple has shown that you can do some interesting things with it. We’re working with customers that may be able to use FHIR for some of their needs, but they have other needs as well. We are able to provide APIs that fulfill needs that the FHIR working groups haven’t gotten to yet or that haven’t been deployed by the vendors yet.

There is no “one size fits all” solution for data exchange. We know from our growth over the last few years and from the continued interest that we have from new customers that there’s a demand for FHIR and more.

Do you have any final thoughts?

The next generation of software that will be part of the digital health revolution demands data liquidity. When you have free flow of data, it’s fascinating what you can accomplish.

The easiest analogy that I draw is to the smartphone. As a platform integrating your location and the ability to send messages, the smartphone has enabled whole categories of industries to develop. Take ride-sharing, for example. That never would have been developed.

As we start to break down the barriers among health IT applications and create the ability for them to exchange data, we’re going see a similar explosion in the creativity and innovation around health IT software. We are excited to be able to support that. For all of us, it will mean a better patient experience, lower costs, and better outcomes. That’s what we’re all trying to achieve.