News 7/4/18

Top News

UK-based private equity firm Hg will buy Orion Health’s Rhapsody healthcare integration technology business for $138 million and will pay another $14 million to acquire a 25 percent share of its population health unit.

In a complicated transaction, Orion will then reinvest some of the proceeds to buy back equity from the same acquirer, leaving it with 25 percent of Rhapsody and 75 percent of population health. It will use the rest of the money to buy back shares and fund its hospital division.

Orion shares, traded on the New Zealand exchange, rose sharply on the news but are still down 81 percent since the company’s December 2014 IPO.  

Reader Comments

From Gaunt Survivor: “Re: HIStalk ‘like’ buttons. Which items have earned the most votes?” That’s an interesting question since I’ve never looked at the statistics from those little thumbs up/down icons I added to each post and comment, and in fact I didn’t know I could look up historical results. The all-time top three items by net score (likes minus dislikes over the past 18 months since I first turned on voting) are a diverse group:

• Readers Write: A Prescription for Poor Clinician Engagement with Health IT: Stop Communicating and Start Marketing
• Book Review: “Bad Blood”
• The Smokin’ Doc Celebrates a Successful HIMSS

From Sprachen: “Re: telemedicine. Some harsh tweets say it was overhyped.” The virtual visit companies have certainly hyped themselves (which is what companies do, especially when they are trying to create a new consumer market) and uptake has been slower than you might expect because of state-specific laws, reimbursement issues, and natural market consolidation. However, there’s no way telemedicine can fail to attract a significant share of some market elements — specifically non-urgent acute issues, mental health, and chronic disease management – because it eliminates the geographical challenges that are caused by irregular provider distribution and challenging physical access. The biggest challenges to telemedicine vendors are (a) they have to market directly to consumers, which is expensive and difficult; and (b) they have to maintain a supply of competent providers who are wiling to conduct video visits at reasonable compensation levels. They have an advantage that both insurers and consumers should find appealing in that they can operate as a de facto national medical practice that is professionally managed to follow sound medical standards defined by policy and procedures and measured by analytics across a broad scale, which could be a lot better than a rogue independent doctor whose practice patterns stray from the accepted. There’s actually a third challenge that sounds worse than it is – it’s not as good as having access to your regular doctor via email or telephone, but most medical practices are eliminating that threat by hiding themselves behind the four walls of their insurance billing factory.

HIStalk Announcements and Requests

Listening: new from The Wild Feathers, which breaks my lifetime-long streak of never recommending a country-rock band. It’s like the Eagles with the annoying parts excised, with remarkable harmonies and enough minor chords to keep me from quickly flipping on. I only wish they would ditch the cliché cowboy hat affectation that is emblematic of Nashville-based artists even though I’ve never seen anyone the South (except for Texas) wear a cowboy hat in public since they have no actual cowboys, especially the kind that work indoors at night miles away from the nearest horse that they couldn’t ride anyway.

It’s the beginning of the July Syndrome, when fresh batches of frightened, newly minted medical residents begin working in US hospitals in scarily defining why we call it the “practice” of medicine. You will be well advised to steer clear for non-emergent needs for the next month or so.

Webinars

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

Acquisitions, Funding, Business, and Stock

Laid-off IBM Watson Health engineers describe the challenges faced by the company following its expensive acquisition of Phytel, Truven, and Explorys in 2015-2016 in trying (and failing so far) to turn its $15 billion investment into profits:

• Phytel employees thought they would accomplish great things under IBM, but has seen the company lose half its clients and 80 percent of its employees
• IBM halted everything Phytel was doing for the first post-acquisition year as it “bluewashed” the company by making it do things IBM’s way
• Non-technologist IBM leaders tried to create new Watson products from the capabilities of its acquisitions, but didn’t have clear ideas, kept changing their mind, and sketched out products that were impossible to create
• IBM is losing the war to attract AI talent
• Former engineers say IBM is “not anywhere close to injecting AI into the provider space” as the planned new products don’t use AI
• Asking Phytel’s customers what they wanted resulted in their demand to bring back the pre-IBM product

Rock Health’s Midyear Funding Review says:

• Digital health investments continue to grow at a record pace
• Startups are increasingly having their products validated even in a post-Theranos shadow
• Two-thirds of digital health investors have made previous deals in the sector
• M&A activity is down from its 2015 high as companies are staying private longer even when they have raised more than the $136 million average of previous IPOs, instead choosing to be acquired pre-IPO
• Half of the digital health companies acquired so far in 2018 were bought by other digital health companies, although the number overweighted by virtual visit providers that aren’t really technology companies

CNBC notes that e-cigarette maker Juul – whose USB-recharged vaporizer is easily concealable before and during use — is enjoying an 800 percent sales jump and a valuation of $15 billion, even as public health experts warn that while the company claims its products are intended to help adults quit smoking tobacco, many of its users are teens and adults who have never smoked. The company and its knock-off competitors offer nicotine-containing pods in such flavors as apple honeydew, donut cream, and Gummy Bear.

Sales

• University of Mississippi Medical Center chooses Kyruus’s ProviderMatch for Access Centers to allow call center agents to identify the right provider based on a patient’s needs.

Announcements and Implementations

Japan’s first telemedicine intensive program goes live, developed in conjunction with Philips.

Government and Politics

Politico reports that the VA will not continue its Epic-powered MASS scheduling project beyond the pilot stage and will instead use Cerner’s capabilities. The VA ended up spending $28 million of the $624 million contract. However, the publication has since issued a “clarification” that its original report was incorrect, and the VA in fact hasn’t yet decided whether to continue the MASS project.

Privacy and Security

A former peer review coordinator of Memorial Hermann Healthcare System sues the health system, saying it fired her for her refusal to reveal confidential surgery-related information at open meetings.

A developer whose company’s mission-critical monitoring application runs on Google Cloud is dismayed to find his entire site down, shut down hard by Google’s automated systems after “potential suspicious activity” with warnings that the entire site would be deleted within three business days. He reports that Google’s customer chat was offline and no support telephone number was provided – Google requires completing an online form and attaching a scan of the credit card use for payment as well as the holder’s picture ID, requiring him to wake up the company’s CFO in whose name the card was issued. He advises using Amazon Web Services instead, having experienced this problem twice with Google Cloud.

In England, NHS Digital blames one of its technology vendors (TPP) for failing to send it patient opt-out requests, a just-uncovered problem going back to 2015 that has caused the information of 150,000 patients to be shared against their wishes.

Other

Stat profiles Biobot Analytics, whose technology analyzes a city’s wastewater as a “public health observatory” that uses “wastewater epidemiology” to perform population-level, toilet-based studies. The company’s challenge is that cities don’t really want to know (and to have publicized) their incidence of opioid use and it would merely confirm the extent of a problem already known to be extensive.

The New York Times says people are being unnecessarily frightened by false positives after they send information from their consumer genetic tests to third-party analysis companies like Promethease, which looks for health-related mutations in the raw data of companies like 23andMe even though they aren’t certified clinical laboratories. The other (unstated) issue is that like much of today’s sophisticated diagnostic testing, we can recognize and name it without being able to fix it.

This medical versus financial decision repeats itself endlessly every day in the only country where an urgent medical need can leave you broke for the rest of your life.

Cordova Community Medical Center (AK) won’t close after all, despite having warned the community that it would shut its doors on July 1 when it expected to run out of money to pay for the Internet access that its computer systems require. The hospital CEO says the FCC’s cuts to the Rural Healthcare Fund left the hospital to pay for its Internet access in full, leaving it with an accumulated $1 million bill. The hospital didn’t say how it resolved the issue, although the FCC boosted the program’s funding on June 1 to account for inflation, possibly restoring the subsidy that allowed the hospital to receive $80,000 per month worth of broadband services for $1,000.

A Detroit jury awards a 17-year-old girl a $135 million judgment in her malpractice lawsuit against Detroit Medical Center, which she claims botched her spinal surgery when she was 10 and left her with permanent weakness that the hospital says was due to a blood clot.

Reno, NV police arrest a 31-year-old man who was running around a hospital’s public areas wearing scrubs and a doctor’s nametag, although he wasn’t booked for that charge specifically since he didn’t identify himself as a doctor and there’s no law against “just throwing a stethoscope around your neck and walking around.” The charge involved a similar incident at a different hospital in which he came in as a patient and then decided to video himself wearing someone’s scrubs. He has led an interesting life – he had two airplane crash landings in two days after convincing aircraft owners that he was a pilot and potential buyer and needed to take their planes up for test drives, then crashing them. His scrubs in the video carry the name of “Denver Prinz, MD,” suggesting that he might be this guy (Prince Denver of Prussia) who claims to be a prince, a charity CEO, a friend to countless celebrities (“my friend Jeff Bezos, owner of Amazon”), a talented keyboard player (whose fingers aren’t shown and whose body movements clearly don’t match the music), and a pilot of everything from helicopters to stunt planes.

Sponsor Updates

• Waystar (the former Navicure and ZirMed) rolls out its “The All-New Rev Cycle” branding campaign at the HFMA annual conference.

Blog Posts

• The Cost of a Lost Minute in the OR (Access)
• The Top 10 Spokwise Healthcare Blog Posts of All Time (Spok)
• How can Application Managed Services help your organization? [podcast] (Nordic)

Contacts

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

Morning Headlines 7/3/18

VA looks to scrap Epic scheduling contract

Politico reports that the VA will not move forward with its MASS patient scheduling project – powered by Epic — despite recent assurances that a system-wide rollout would be much cheaper and faster than originally estimated, choosing to go with the equivalent Cerner modules instead.

Layoffs at Watson Health Reveal IBM’s Problem With AI

Employees of acquired companies Phytel, Explorys, and Truven are hit hardest by staffing cuts as laid-off IBM engineers claim that former KLAS-topping population health management technology vendor Phytel has lost half its customer base and 80 percent of its employees under IBM’s ownership.

Toolkit: Using Data Analysis To Calculate Opioid Levels and Identify Patients At Risk of Misuse or Overdose

HHS OIG releases a SAS-powered tool that allows health plans to analyze their prescription drug claims data to identify at-risk patients.

Netsmart Finalizes Acquisition of Change Healthcare Home Care and Hospice Solutions

Netsmart completes its acquisition of the solutions formerly owned by McKesson.

Curbside Consult with Dr. Jayne 7/2/18

I received quite a bit of correspondence after my recent piece regarding the CareSync shutdown. I had some pushback about my comments about the risk of working for a startup, where I said, “For people higher in the company who fully understood what it means to be part of a startup, they are likely prepared for such a scenario. For lower-wage workers on the front lines, especially for those living paycheck to paycheck in a relatively tough economy, it’s devastating.”

One correspondent essentially blamed the employees, stating they should have known that working for a startup is risky. I would argue that there were probably a fair number of people who worked there who either didn’t understand that they were working for a startup or didn’t fully understand what kind of risks are inherent in that situation. If you’re a nurse or care coordinator who isn’t as familiar with the healthcare IT space, it might look pretty good. Especially when a company leases a shiny office building and hires a couple hundred workers, people might not register that it’s a startup.

Even in established companies, there can be startup-type projects that put workers in as much jeopardy as they might be with a startup, but it’s not obvious. I watched some of my dearest friends get downsized when their company blew through scores of millions on a project, only to shut it down while the rest of the company went forward in a profitable state.

Another reader commented on the issue of survivor’s guilt:

I read your blog about CareSync today and found myself nodding my head in agreement at most of your points. I’ve been working for a startup company the past couple of years. Prior to that, I held a variety of roles in a different industry, where survivor’s guilt was a daily thing. I can’t tell you how many hundreds of jobs I saw disappear, often for selfish reasons such as protecting the C-suite’s annual bonus. At some point, I had enough and retired and that’s how I ended up in healthcare IT.

There is a huge difference between that industry and healthcare IT. The major players all have negative sales growth, and any growth you see on their quarterly statements comes from expensive acquisitions instead of organic growth. Healthcare IT is experiencing a nice growth curve still since most practices are underserved in my segment. I talk to many different practices weekly and each of them appreciates the help we give them.

The CareSync debacle just highlights the fact that there are people running businesses that they shouldn’t be. Given the amount of funding CareSync received, it is clear to me that they did not have a sustainable business model. The C-suite should have either pivoted or reorganized to a sustainable model. After what happened at Theranos, if I were a CareSync investor, I would be looking into whether or not a crime was committed.

I’m not the legal eagle in the family so I can’t comment about the criminal piece, but these types of examples should give investors pause and encourage them to ask more questions about the businesses they are supporting. I’ve been asked several times to support ventures in a much smaller capacity, from money to labor, mostly because of the personalities involved and their track record for success. Even though I’m a small investor, you have to do due diligence. Just because someone made money in the past in one industry or another doesn’t mean they understand healthcare IT.

I did a deep dive into a company that was courting one of my relatives as an investor, and not only was there really not a market for their product, but how they were approaching it was flawed. It was a bolt-on user interface designed to “improve the EHR experience,” but they were going after it by trying to court major EHR vendors. I gave them a bit of free advice — it’s probably not the best idea to go to a vendor and call their baby ugly. Maybe they’d have a better shot at going after either a regional or specialty-specific user base and getting some grassroots traction then moving up from there and trying to be acquired by a vendor. They ended up cold-calling a bunch of vendors and have gotten exactly nowhere in the last three years.

I also heard from one of my favorite healthcare startup CEOs, whose response made me respect him even more than I already did:

Today’s post is near and dear to me, as it is something I battle every day as an employer in this space, especially in a startup-like environment. I take very seriously the lives I am in control of. I worry greatly about what could happen if bad things happen and I need to make significant cuts. I would have to be a sociopath to not lie awake with that concern as it relates to each client / prospect / lead we are trying to get business and revenue from. If we lose all of our clients, what will I tell the people who rely on our bi-monthly paychecks to feed their families and cover their expenses?

First, I make clear to the entire organization, from board to rank-and-file folks, that everything is subject to change. Even though runway is a great indicator of longevity for overall company success, growth, and existence, that doesn’t mean that there are no risks whatsoever. If projects / prospects don’t come through, certain folks will inevitably face a departure. Fundraising concerns are also a part of it, and with each pitch, it is my job to make sure the health of the company (and therefore the team itself) is well taken care of. Even with revenue, capital, a great plan, and strong leadership, no company is truly protected and no employee is truly safe. It is my job to provide opportunity for folks, protect that opportunity as a condition of their employment, but also be smart and savvy about investment and spend every day. If you come into a company and start counting share price on equity and think it is all rosy, you’ll probably be the first to be shocked if and when things don’t go as planned.

Second, I suggest to employees that not get too whimsical in their spending. I toe a delicate balance, but try to instill in every employee, from executive to intern, the realities that could present themselves and what it would mean to be 180 days without income. This has happened to me earlier in my career, so I can speak from experience — if you aren’t prepared, you will struggle. Saving, being cautious with spending, and being aware of the frailties of life are messages I try to impart during regular check-in with all employees. They don’t teach people these skills. Many assume that the career ladder is a short hike up stairs. Few are aware of what may lie ahead, and it should scare everyone.

Third, I have a separate near-term savings that is a rainy-day fund. Not for purchases, travel, college savings, or retirement, but an account that I fund every month that could carry the family through any immediate challenges that could be faced. Whether it comes with having elderly parents who have poorly prepared for retirement, small children who are likely to need care that may not be covered, or pets that will do absolutely idiotic and expensive damage to themselves and the world around them, I think I have enough liquid capital to get through a rough patch, which took over a decade to stash away. It pains me to think of the things I missed out when I was younger by putting so much money aside, but it makes more and more sense each passing day when I hear stories of friends, neighbors, and colleagues going through career issues that are really scary.

Whether you run a health tech startup, work for one, or are working for a huge health system in any capacity (I have been all three), I think it is important to reflect on your immediate needs in a responsible way. Nothing is guaranteed in life, nothing lasts forever, and getting a heads-up doesn’t normally happen.

I’ve worked with several CEOs who spend money like water and it’s not always clear whether it’s personal money or the company’s money. Knowing my own temperament, I would prefer working for someone who is willing to talk to employees about the possibility of a downturn and his own rainy-day planning rather than talk about his new boat or her condo in Aspen. You may be buying the finest liquor and the best cigars, but how are you doing running the company?

I once worked with a hospital CIO who kept the security camera footage of his house in the Florida Keys running continuously in a window on his desktop, mostly to show off his dock and his boat. The only thing I could think of was how much time he was wasting every day.

My CEO friend went on to hypothesize that perhaps his conservative attitude towards finances comes from being “in healthcare” since we see people who have life-changing medical issues or end up changing their own career plans to care for others. I agree, but also think some of it is also generational, since many people in my age bracket are working under the assumption that Social Security will be a historical footnote by the time we are of retirement age. He went on to close with this:

One last thought on this topic. I don’t think it is specific to healthcare or startups. I just had a friend that works in insurance / re-insurance for the past 25 years get RIF’ed on a random Friday. The entire team of a Fortune 250 company was cut as the company migrates to blockchain. I can laugh about the blockchain part, but the reality is that here is a mid-50s executive who was part of a mass cut of staff unexpectedly. Three kids, mortgage, college for at least one child. How prepared are even the most well-heeled Americans from the unlikely (though statistically incredibly likely) scenario where job goes away and the next one doesn’t seem like it will come too easily?

The blockchain reference definitely made me chuckle, but it’s a serious topic. If you’ve been “released to the workforce,” what advice do you have to give that you wish you knew before the layoff? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Opioid Crisis: Fix the Process, Fix the Problem

The Opioid Crisis: Fix the Process, Fix the Problem
By Brita Hansen, MD

Brita Hansen, MD is chief medical officer of LogicStream Health of Minneapolis, MN.

As the nation continues to grapple with the overprescribing and misuse of opioids, reaching a solution often feels far out of reach. According to the US Department of Health and Human Services, more than 11 million individuals have been documented as having misused prescription opioids, resulting in an alarming 116 opioid-related deaths daily.

Despite this growing epidemic, provider organizations are uniquely positioned to address a key issue contributing to improper prescribing practices – inefficient clinical processes. Outdated and obsolete clinical processes built into electronic health records (EHRs) can be significant factors driving inappropriate drug utilization and impaired patient safety and quality care.

While the opioid crisis has no single origin point, one contributing factor can be traced back to the early-2000s when the Joint Commission implemented its revised pain management standards in response to the under-treatment of pain that was reported throughout the industry. In turn, many healthcare organizations interpreted these standards as a mandate and began to adopt clinical processes that aggressively treated patients’ acute and chronic pain. This also contributed to the then-growing trend of patients and caregivers equating pain management with medication use, which led to a demand that helped drive the increase in opioid prescriptions, and subsequently, opioid-related abuse and overdoses.

Despite evolving patient expectations and the emergence of new best practices for opioid prescribing, EHRs still lack the ability to appropriately guide clinicians and provide effective decision support during the prescribing process. Further, healthcare organizations also face the challenge of ensuring that clinicians understand and adhere to both general opioid ordering practices and best-practice guidelines. Gaining insight into these clinician’s ordering habits has been a continuous issue, and while clinicians express interest in reviewing and improving their ordering practices, this information is difficult and time-consuming to gather.

In addition to fixing and controlling processes and improving clinician adherence, provider organizations must ensure content in EHRs are continuously and reliably aligned with evidence-based guidelines to enable sustainable opioid therapy. For instance, recently developed treatments limit patients’ exposure to opioids, and instead, provide them with powerful yet non-addictive drugs such as corticosteroid injections for rapid pain relief and local anesthetics used during surgery or physical therapy sessions.

Facing the pressures to curb the country’s misuse of prescription opioids and adhere with rapidly changing prescribing guidelines, many healthcare organizations are increasingly leveraging health IT to encourage and improve the use of evidence-based best practices at the point of care. However, these tools are only as effective as the upstream clinical processes governing them, processes that are too often overlooked in the overall improvement strategy.

The data and trends contained within EHRs provide the key insights needed to optimize, measure, and manage the clinical processes related to opioid prescribing. With this critical information, frontline care teams can target and eliminate obsolete opioid protocols and order sets, thereby helping to improve, standardize, and better control processes and decrease the variability in how opioids are prescribed.

By identifying inefficiencies in workflows and the EHR build that often drive inappropriate prescribing practices, care teams can eliminate these issues. With the right tools, they can also continuously monitor the clinical processes guiding opioid prescribing and ensure they are aligned with current clinical evidence, regulatory requirements, and internal workflow needs. It’s equally imperative to continuously monitor clinician interaction with and adoption of the clinical processes that have been implemented, as various barriers inevitably lead to low compliance with set prescribing standards and protocols among some clinicians. Regular monitoring of opioid ordering enables clinical leaders to identify outliers, address barriers, and deploy appropriate interventions as needed.

To truly address the current opioid epidemic, provider organizations must fix the process to fix the problem, which begins with maintaining upstream improvements to clinical processes guiding opioid prescribing. While these steps may be one part of the nation’s opioid strategy, they remain key to providing healthcare organizations with the proactive support needed to combat the crisis.

Readers Write: Why It’s Time to Make Clinical Documentation Clinically Valuable

Why It’s Time to Make Clinical Documentation Clinically Valuable
By Jay Anders, MD, MS

Jay Anders, MD, MS is chief medical officer of Medicomp Systems of Chantilly, VA.

“I love documenting patient encounters,”said no clinician ever.

Clinical documentation is a time-consuming source of frustration for physicians and nurses, yet a necessary evil for any hospital and health system that wants to keep its doors open and its lights on. Clinical documentation drives the billing process, maintains the details for diagnosis and procedure coding, and provides the required justification for reimbursement.

The whole “billing and getting-paid” stuff is obviously important, but what if we could transform the clinical documentation process to make it more valuable to the physician and the patient? In other words, why not “fix” clinical documentation so that it helps clinicians deliver better patient care?

Consider the typical clinical documentation process for a patient encounter. The doctor sees a patient who, for example, is complaining of an irregular heartbeat. The physician pulls up an arrhythmia template in the EHR and begins documenting the patient’s symptoms. Everything moves along smoothly until the patient mentions that he’s recently been having some pain in his right elbow. And, that his A1C levels have been a little elevated.

Suddenly the documentation process gets a lot more complicated as the physician hunts for template options to document the non arrhythmia-related ailments. After a couple of minutes searching unsuccessfully for the right disease templates, the doctor gives up and decides to dictate the rest of the note.

Because of the inefficiencies of most clinical documentation systems, physicians often resort to dictation. The transcription of dictated notes can be expensive and is prone to error. Furthermore, dictated data is stored in a non-structured format that is more difficult to access at the point of care. This means that physicians may overlook critical details hidden within free text, which in turn can impact the delivery of care. In addition, it’s difficult to analyze data in an unstructured format for quality reporting purposes or for any type of analytics.

Physicians and their patients deserve better. Here are my recommended “fixes” to give clinical documentation more clinical substance for the enhanced delivery of patient care.

Clinically-dynamic, patient-specific documentation

More physicians now have access to disease-specific templates, which give clinicians a great head start in the documentation process and help with the capture of structured data for larger quality improvement initiatives. However, because physicians treat whole patients and not a single disease, clinicians also need documentation tools that are patient-specific and clinically-dynamic.

With a clinically-dynamic documentation platform, physicians can easily pull in clinically relevant items without having to call up multiple templates. In the case of the patient complaining of an irregular heartbeat, a doctor can tap in a few keystrokes and quickly add new issues into the existing document. The documentation workflow is not disrupted and the clinician does not need to dictate any details or enter free text. Everything related to the patient, including the elbow pain and A1c concerns, are merged directly into the same note. Each element is logically linked to the relevant section within the note – the problem list or physical exam, for example – so that physicians can quickly access the precise details at any time.

Capturing patient-specific details for quality initiatives

You may never hear a physician say they love documenting patient encounters, but you may be able to convince them that it’s worth the effort if the finished product facilitates better patient care.

When clinical documentation can be leveraged to advance quality initiatives, physicians are less likely to view the charting process as a time-consuming task that turns doctors into overpaid members of the billing staff. With smarter clinical documentation tools, physicians can track more patient data in real time and capture critical information that feeds analytics systems and performance dashboards. Clinicians can then access population-level information or view specific clinical details in a longitudinal format and gain deeper insights into a patient’s medical status.

It’s time to usher in a new era with clinical documentation. With the right technology and a shift in mindset, we have the opportunity to transform clinical documentation so that it’s not just about coding and billing, but instead a vital tool that enhances the delivery of quality patient care.

Readers Write: EHRs Have Not Reduced Paper Usage Yet. Why? And How Do We Change This?

EHRs Have Not Reduced Paper Usage Yet. Why? And How Do We Change This?
By Chris Click

Chris Click is senior healthcare solutions manager of document imaging for Nuance of Burlington, MA.

EHRs have numerous advantages. Foremost among them, patients’ health records are readily available and stored securely. Despite these benefits, hospitals report an 11 percent increase in paper usage, driven by Meaningful Use, the Affordable Care Act, ICD-10, and the adoption of electronic record-keeping. This begs the question — why is paper usage increasing as hospitals adopt EHRs?

According to Health IT Dashboard, in 2016, more than 95 percent of all eligible and critical access hospitals demonstrated Meaningful Use of certified health IT, including EHRs. Unfortunately, doctors are not always happy or comfortable with this widespread adoption of health IT. Physicians Practice’s 2017 Technology Survey found nearly 43 percent of physicians cited issues with their facility’s EHR as the most pressing IT-related concern. In the same survey, about 75 percent of respondents agreed that health IT is failing because doctors generally do not like the technology available to them.

Physicians’ dissatisfaction with their facilities’ EHR systems lead them to print out patient records rather than work from the device’s screen. Evidence points to this being the case; according to one recent US survey, 88 percent of respondents said they understood, retained, and used information better when they read general documents on paper as opposed to on electronic devices.

Things do not have to be this way. Healthcare organizations need to supply their medical staff with tools to make EHRs easier to use and eliminate unnecessary printing and paper-based records in general, while also maintaining a high level of patient convenience and satisfaction.

Paper is still prevalent in healthcare facilities. Not only because doctors seem to prefer it over EHRs, but because patients often arrive with a variety of paperwork: admission forms, consent forms, pharmaceutical records, referrals, and insurance forms. EHRs can store all this information, but manually entering the information can be an onerous task that leaves patients waiting. Therefore, it’s necessary for healthcare facilities to equip their staff with tools to streamline the intake process and automatically input patients’ information into their EHRs. Installing optical character recognition (OCR) technology onto office scanners and integrating the device to the facility’s EHR will enable administrative staff to scan documents and have the information automatically uploaded into the EHR, saving time for both staff and patients.

Doctors are also spending more time with EHRs and less time with patients. A 2016 study in the Annals of Internal Medicine found that nearly 49 percent of doctors’ time was spent on EHRs (updating them, inputting notes, etc.) while just 27 percent was spent with patients in direct clinical engagement. Giving doctors tools to make recordkeeping easier will give them more time to interact with patients.

Hospitals should consider giving their medical staff voice recognition or OCR tools. Both have become practical alternatives to typing and are a much faster, simpler way to transcribe doctors’ notes into EHR systems. A recent study showed that voice recognition software is faster and more accurate than typing, and OCR technology, when paired with document scanners, can convert paper documentation such as patient reports and clinical tests into searchable content for immediate use by the clinician in the EHR.

When EHRs are updated more promptly and accurately, physicians’ confidence levels in them will increase. If physicians know that inputting notes will be significantly easier than in the past, this will encourage them to reduce their reliance on paper and instead leverage more modern, convenient techniques. All of this will help reduce the volume of paper and printing.

Healthcare facilities that do not set parameters at the printer leave open the possibility of staff abusing printing privileges and disregarding resource consumption. Equipping multifunction printers (MFPs) with software that creates an audit trail of print jobs can help healthcare facilities manage costs and resources by allowing them to see who is printing and the associated volumes.

In addition to reducing paper volumes and costs, printers can also ensure a higher level of security for sensitive data residing in paper documents. There is software available that enables including “follow-me printing,” which holds documents in a secure print queue until the user authenticates themselves at any network MFP. This ensures that only privileged users can print certain documents and offers better safeguards PHI residing in paper documents by eliminating the scenario of sensitive documents being left unattended on the printer tray.

The healthcare industry’s paper problem can be solved, but reaching Meaningful Use alone hasn’t done the trick. Transitioning to a paper-light operation will require supporting technologies to augment the benefits of a facility’s EHR while at the same time installing better tools to help both physicians and administrative staff streamline processes and while also keeping sensitive, confidential patient data secure.

Morning Headlines 7/2/18

Why telemedicine has been such a bust so far

CNBC’s Chrissy Farr says lack of awareness, cost, and the desire for human interaction are responsible for the lack of widespread use of video visits.

T-System President and CEO Roger Davis resigns

The company confirmed the June 30 departure of Davis, but did not issue an announcement

As Part of National Healthcare Fraud Sweep, Los Angeles-Based Prosecutors Filed 16 Cases Alleging $660 Million in Fraudulent Bills

A former hospital owner is charged with paying $40 million in kickbacks over 15 years to generate $950 million in fraudulent hospital charges for surgeries, compounded drugs, home health services, and hospice care.

Medicare spent $2 billion for one drug as the manufacturer paid doctors millions

Claims analysis finds that 80 percent of the doctors who prescribe Acthar Gel are receiving checks from the company for speaking fees as the questionably useful drug’s cost has increased from $40 per vial in 2000 to $39,000 today.

Monday Morning Update 7/2/18

Top News

CNBC’s talented and prolific reporter Chrissy Farr (she’s smart because she listens instead of talks, unlike most vain, vacuous TV talking heads whose raison d’etre is a buffoonishly gleaming smile rather than journalism) ponders why telemedicine “has been such a bust so far,” as 82 percent of Americans don’t use it.” Reasons:

• People don’t know about it
• Companies use the word “telemedicine,” which consumers don’t understand
• Patients worry about the cost since most video visits require cash payments that aren’t affordable to a lot of people
• They worry that doctors who are willing to offer video visits may be inexperienced or questionably skilled
• Sick people want personal reassurance that an app can’t deliver
• The common $75 charge is more than the co-pay of a doctor visit and not much less than a Minute Clinic cash visit

Still, I’m not sure I’d call telemedicine a bust. It only recently overcame technical and legal challenges to enter mainstream healthcare and its potential to more geographically evenly distribute medical expertise is promising. We have plenty of doctors, just not enough of them in primary care and an overabundance in big cities like Boston and New York where doctors prefer to live.

I’ve never had a video visit myself, but I would be more inclined to use it for a conversation with a skilled specialist in obtaining a second opinion since I have my $60-per-month concierge doctor available at all times anyway. 

Reader Comments

From Ms. Security: “Re: Quest Diagnostics. Their online bill password protection is a joke — MM-DD-YYYYZIPCODE.” Unverified. I registered on MyQuest to see how it works – the site requires creating a case-sensitive password that’s at least eight characters long that contains at least one alpha and one numeric or special character. Maybe it varies by the way the site is accessed.

HIStalk Announcements and Requests

Two-thirds of poll respondents admire and respect their employer’s big boss.

New poll to your right or here: provider employees, how many work days do you spend attending conferences each year? I admit that I’m skeptical that conference attendance delivers employer value beyond giving providing an ego stroke for employees who enjoy feeling important among external peers (for which patients are paying, of course). However, I acknowledge those who say their attendance is important for building relationships with vendors and staying current (OK, I’m still skeptical).

Happy birthday, Canada (July 1) and United States of America (July 4).

I was in Trader Joe’s early on a recent morning and was surprised to hear the immediately recognizable opening and then the growling Hammond organ of “Fire” by the bizarre 1960s psychedelic band The Crazy World of Arthur Brown, which made my day as I felt a secret, shared rebelliousness with a grocery store that is too cool to play “Daydream Believer.” In fact, I’m picturing a dramatic opening for presentations by FHIR expert Grahame Grieve, in which he takes the podium wearing a giant flaming helmet as an overdubbed version of “Fire” blares with these modified lyrics: “I am the god of health FHIR and I bring you FHIR. I’ll take you to learn.”

Webinars

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

Acquisitions, Funding, Business, and Stock

I’m fascinated with the comments of investor and technology executive Dave Kellogg, who ponders the “does the emperor have clothes?” question in reviewing the S-1 filing of BI tech vendor Domo, about which he observes (think of Theranos as you read this):

• The Silicon Valley goal is now to raise more capital, generate more hype, and buy the most customers.
• The ratio of venture capital to annual recurring revenue is the “hype factor,” for which Domo’s is 6.4, meaning “you give them $1 and you get $0.15 of heat and $0.85 of light.”
• The founder controls nearly all the voting shares.
• The company’s growth is leveling, but its burn rate is $150 million per year and it carries an $803 million accumulated deficit.
• Market penetration is less than 4 percent.
• The company leases a private jet from the founder for $1 million per year and spends $300,000 per year on catering by a company owned by the founder and his brother.
• Kellogg says Domo is “the Kardashians of business intelligence” in being famous for being famous as its product description is nearly indecipherable other than it uses a lot of VC buzzwords in concluding that its product “enables CEOs to manage their entire company from their phone.”

Sales

• Duke Regional Hospital (NC) chooses Glytec’s EGlycemic Management System for insulin therapy.

Decisions

• Community Hospital of Staunton (IL) will switch from Evident to Meditech in November 2019.
• Beatrice Community Hospital & Health Center (NE) will replace Allscripts with Epic on December 1, 2018.
• Neshoba County General Hospital (MS) will go live with Cerner in February 2019.

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

People

T-System President and CEO Roger Davis has resigned, verified by the company in response to my query from a reader-reported rumor.

Government and Politics

Los Angeles prosecutors name nine new defendants, including a former hospital CFO and three orthopedic surgeons, for their alleged participation in a kickback scheme involving surgeries, compounded drugs, home health services, and hospice care as orchestrated by the former owner of Pacific Hospital on Long Beach, CA. He is charged with paying $40 million in kickbacks to generate $950 million in fraudulent bills over 15 years. Orthopedic surgeon Daniel Capen, MD (above) will plead guilty for his part in creating $142 million in fraudulent bills, for which Pacific Hospital was paid $56 million. Michael Drobot, the former hospital owner, was sentenced to 63 months in prison earlier this year for billing worker’s compensation hundreds of millions of dollars for spinal surgeries for which he paid kickbacks of up to $15,000 per case, which he funded by billing the hospital at inflated prices for spinal surgery implants used in the cases. He also bribed a state senator to keep the spinal device law in effect, for which the former senator went to prison. The federal government rather wittily refers to its investigation as “Operation Spinal Cap.”

Other

Don’t read this if you’re of the “healthcare is a calling, not a business” frame of mind. Atrium Health (the former Carolinas HealthCare System) replaces its anesthesiology group for refusing to lower their prices, choosing instead a local group based in Charlotte. The displaced group, which is owned by a publicly traded company valued at $4 billion, launches a media campaign that warns the public that the decision will jeopardize patient safety and says the health system’s previous cost-cutting efforts simply padded its bottom line to pay for huge executive salaries and its aggressive expansion. The company also notes that its anesthesiologists signed non-compete agreements that prevent them from accepting the job offers that the new company made.

More US healthcare system madness as uncovered by Medicare claims analysis that would make Martin Shkreli beam with pride from his prison cell:

• An old drug whose only approved use is for a rare condition in babies was being sold by Drug Company A for $40 in 2000.
• Drug Company B bought the drug’s rights for $100,000 in 2001 and immediately raised its price to $750.
• Drug Company B kept raising the prices, including a 2007 jump overnight from $1,600 to $23,000.
• Drug Company C bought Drug Company B in 2014 and raised the price another $7,000.
• Drug Company C immediately began aggressive promotion of the drug for questionable uses that included paying speaking fees (“peer-to-peer speaking engagements”) to doctors, writing checks to 80 percent of the drug’s prescribers.
• Medicare spent $2 billion on the drug from 2011 to 2016 even though far cheaper drugs, such as prednisone, work just as well.
• Overall, the drug’s price has been increased from $40 to $39,000 per vial and the company boasts that “current regulatory guidelines … make a generic unlikely.”

Don’t show up here with a medical emergency. Despite its appearance and name, CHI Health Center isn’t a hospital – the Omaha arena that hosts concerts and wrestling matches sells its naming rights to CHI Health (part of Catholic Health Initiatives) for $24 million over 20 years. 

Sponsor Updates

• Definitive Healthcare is named as the 5th Best Place to Work by the Boston Business Journal.

Blog Posts

• Creating a successful Community Connect program (Nordic)
• Getting Medications Out of the Bottle: The Importance of Patient Engagement (First Databank)

Contacts

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

Weekender 6/29/18

Weekly News Recap

• Amazon announces that it will acquire mail order pharmacy PillPack for a rumored $1 billion in cash
• Cerner settles an unpaid overtime employee class action lawsuit for $4.5 million
• The VA says it will bring three sites live on Cerner by 2020
• GE announces that it will spin off its GE Healthcare business into a standalone company
• A GAO report finds that the VA was spending $1 billion per year on VistA, but needs to consider how to replace the nearly 50 percent of VistA applications that don’t have a Cerner counterpart
• Outcome Health’s two co-founders leave its board following their previous departure as executives amidst fraud claims by investors
• Details of CareSync’s closure indicate that a planned acquisition fell through, leaving the company in such dire straits that it sent 292 employees home and closed its doors for good
• Qualcomm seeks a buyer for a majority stake in its Qualcomm Life subsidiary, which includes the 2net remote patient monitoring system and Capsule medical device integration platform
• Allscripts reportedly is offering voluntary retirement to a large number of employees

Best Reader Comments

My spouse has worked at several start ups (non-HIT). It’s amazing how quickly you turn from invaluable employee with critical deadlines to “sorry, you have an hour to clean out desk.” And how easy it is to put your head down to do all the work demanded of you, and then forget to poke your head up often to get the lay of the land. I would always ask, do you see lots of suits crawling around the office?” And before every hatchet, yup, sudden influx of suits in C-level area. (TXY)

Is anyone else alarmed that only 50 percent of the VistA applications will be replaced by Cerner? What “modernization” and “standardization” effort is that going to take so that there aren’t 20 versions of the same points of integration? It is a complex socio-technical environment. This needs to be done well for those who have served the United States of America. (Art_Vandelay)

Don’t expect any major changes for GE’s Healthcare business and strategy in the short-term; the unit was pretty self sufficient in terms of business operations and has had a fairly major cull, “trimming the fat” already. The bigger issue might be the split of cross-division research and development initiatives (big data analytics, IoT), harming competitiveness in the mid term. (Plucky_Brit)

As unfortunate as this is, I think what goes unmentioned is the inherent risk that comes with working at a startup. Having worked for three, I can tell you that nothing, and I mean NOTHING, that happens regarding financing, strategic partnerships, or anything related to funding is guaranteed when you are working for a startup. Is it OK to be optimistic? Absolutely. Is it OK to get excited about your prospects when you hope the company is bought out or sold in the future and you have the options to cash in your chips? 100 percent. My point is that it’s easy to become complacent, and as the CareSync case points out, the proverbial rug can be yanked at any time no matter how rosy things may seem. (John Trader)

The JAMA article which suggests that “HHS should consider creating and enforcing penalties for failure to release all relevant clinical information to treating clinicians in a timely fashion” is a terrible idea. While I agree that HIPAA both by design and by misinterpretation can cause harm I don’t think more legislation is going to fix anything. HHS has implemented a set of often vaguely written regulations for which they fine organizations heavily if they fail to implement properly. Thus, they have created the “better safe than sorry” mentality that seems to be standard operating procedure at many covered entities these days. Creating the type of penalties described would likely be a “damned if you do, damned if you don’t” scenario. (Mike Cottle)

Watercooler Talk Tidbits

Readers funded the DonorsChoose teacher grant request of Mr. M, who asked for math activities for his Significant Support Needs elementary school students in Colorado. He reports, “The students were ecstatic when they opened the boxes for the first time! We have already put the new tools to use. Our students are on such a variety of levels, these materials allow us to modify for each student’s ability. Using them in our small group instruction during math is the primary use. They are always allowed to use them during recess. They love the game portion of the materials. We as teachers, love the learning portion! Our student will continue learning and growing with wonderful donors as yourself. Without you, we would not be able to have such wonderful materials in our Significant Support Needs classroom.”

Kansas City University of Medicine and Biosciences breaks ground on a $33 million simulation center that will use virtual reality and haptic (touch) technology to train its medical students. A Mayo Clinic doctor agrees that simulation is beneficial in keeping up skills, but says low-cost, low-tech versions – Mayo has residents practicing on homebrew patients made of rubber hoses and cardboard that cost as little as $5 – work just as well or better and will be the wave of the future.

Technology companies in China are hoping to cash in on the country’s $1 trillion annual healthcare spending by developing systems that can ease the bottlenecks caused by its vast doctor shortage, especially in remote areas. Among them: ambulance routing, allocating doctors by expected demand, medical image analysis, virtual visits, and Internet-only hospitals that could manage patients and sell prescriptions online.

A JAMA-published study finds that Medicare-insured seniors were in 2015 less likely to die in hospitals instead of their homes compared to 2000. It also notes that while 29 percent spent time in the ICU in their final 30 days, that percentage has leveled off. Hospice use by dying patient increased from 22 percent to more than 50 percent.

The NFL denies the request of its only player-doctor — Kansas City Chiefs guard Laurent Duvernay-Tardif, MD – to append “MD” to his name on the back of his jersey.

I am certain that Weird News Andy never sausage a challenge in researching just the right ICD-10 code for this story. A Philadelphia Phillies baseball fan is injured when the team mascot accidentally shoots her in the face with a duct tape-wrapped hot dog blasted into the crowd from a mobile launcher. She urges fans to pay attention to what’s happening on the field even between innings, but isn’t planning to sue for her tubesteak trauma.

In Case You Missed It

• News 6/29/18
• EPtalk by Dr. Jayne 6/28/18
• News 6/27/18
• Curbside Consult with Dr. Jayne 6/25/18
• Monday Morning Update 6/25/18

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 6/29/18

Amazon acquires online pharmacy PillPack in move into health care

Amazon reportedly outflanks Walmart in buying the mail order pharmacy for a rumored $1 billion in cash.

Cerner to pay $4.5 million to settle overtime claims

Cerner settles an employee overtime lawsuit brought on behalf of the company’s delivery consultants and system analysts.

National Health Care Fraud Takedown Results in Charges Against 601 Individuals Responsible for Over $2 Billion in Fraud Losses

The Department of Justice and HHS OIG announce the biggest healthcare fraud enforcement action in history that crosses 58 federal districts.

VA Electronic Health Record Modernization: The Beginning of the Beginning

The House Committee on Veterans Affairs presses VA executives and Cerner President Zane Burke on the VA’s $16 billion project, which will see three hospitals going live in 2020.

News 6/29/18

Top News

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

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

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

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

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

People

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

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

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

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

Announcements and Implementations

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

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

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

Government and Politics

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

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

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

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

Other

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 6/28/18

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 6/28/18

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

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

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

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

Tampa Bay tech community pulls together to help displaced CareSync workers

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

VA will have 3 Cerner-powered hospitals by 2020

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

Morning Headlines 6/27/18

GE Focuses Portfolio for Growth and Shareholder Value Creation

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

New team assembled to unlock the innovation potential in healthcare data

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

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

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

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

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

News 6/27/18

Top News

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

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

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

Reader Comments

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

People

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

Announcements and Implementations

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

Government and Politics

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

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

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

Other

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 6/26/18

Outcome Health founders step down from board

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

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

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

State switches to electronic health records for prisons

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

Chief Health Informatics Officer

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

Curbside Consult with Dr. Jayne 6/25/18

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.