Morning Headlines 1/25/17

DirectTrust Reports Record Growth in Direct Transactions, Number of Direct Exchange Addresses and Users

DirectTrust reports that there were 98 million messages exchanged across its network in 2016, while the number of addresses capable of exchanging PHI increased 24 percent and the number of healthcare organizations connected to the network grew 36 percent.

£7m EPR costs blowout predicted after delay

In England, delays implementing Cerner Millennium at Calderdale and Huddersfield NHS Foundation Trust are expected to drive the project’s total cost from $6 million to $15 million.

GetWellNetwork Acquires Seamless Medical Systems, Extends Reach to More Than 150 Clinics

Patient engagement software vendor GetWellNetwork acquires Seamless Medical Systems, the developers of a patient check-in and waiting room app that claims to reduce door-to-door time by 40 percent.

Federal Debt Projected to Grow by Nearly $10 Trillion Over Next Decade

A Congressional Budget Office report says that while the economy is on solid ground and increasing job growth is expected, the deficit is projected to swell, adding $10 trillion in new federal debt over the next 10 years.

News 1/25/17

Top News

A federal judge sides with the Department of Justice in ruling that the proposed merger of insurers Aetna and Humana should not be allowed because it would reduce competition.

The judge also scolded Aetna for falsely claiming it exited Affordable Care Act marketplaces because of financial losses, noting that the company’s executives followed through on their threats to punish the market if their merger request was denied. Aetna says that wasn’t a threat, just a reflection of market realities. The companies are considering appealing the ruling.

The “smoking gun” document outlining Aetna’s threat to pull out of even profitable ACA markets came from Aetna Chairman and CEO Mark Bertolini, whom HIMSS invited to give the opening keynote address at HIMSS14, where he talked about integrity and the importance of the ACA marketplace that he predicted would sell insurance to 75 million people.

Reader Comments

From Norma Rae: “Re: AHIMA. A server problem from December 30 is still not resolved, as members paid for CEU quizzes that still aren’t available. AHIMA is not answering messages and the phone wait time is nearly two hours.” AHIMA’s website says it has extended the CEU reporting deadline from December 31, 2016 to March 31, 2017 due to the unspecified technical difficulties of an unnamed outside technology vendor.

From Two Dull Dew: “Re: Capricorn Healthcare’s Epic stake. The private equity firm acquired a very small number of shares from an outside shareholder several years ago. It’s not a significant investment even though they list it on their portfolio page.” Several readers provided the same explanation, with one adding the obvious fact that if Capricorn had somehow loaded up on Epic shares, they would be crowing more demonstratively than just quietly listing Epic’s logo on their portfolio list.

From Deck Pitcher: “Re: Theranos. Here is its first pitch deck.” The 2006 slides feature an amateurish logo and the company’s focus on drug companies as a customer base, where Theranos promised to increase drug sales by improving dose customization and monitoring that it hoped would reduce the need for FDA black box warnings. Theranos said it expected to make $50 million per clinical trial by charging $7,500 for each patient enrolled, which it said is up to 30 percent less than drug companies spend in offering testing in physician offices. The company listed as one of its “drivers for success” its management and culture, which we now know were so toxic that they should have had an FDA (or perhaps SEC) black box warning of their own. Thank goodness Theranos pivoted away from convincing drug companies to let it help monitor toxic drugs using its now-discredited lab tests.

From Peace Out: “Re: HIStalk. You have helped me do my job better. I can chit-chat with a CIO and they perk up if I mention that I read something in HIStalk – we can then carry on a well-informed conversation. I have noticed that folks can tell if one reads HIStalk. I mention your site at least three times when I’m at a client site. Your donor-matching program for kids makes my heart sing.” Thanks – you made my day as I do my empty room/empty screen thing.

From PM_From_Haities: “Re: poor customer service in physician practices. At the end of the day, the clinics rates are fixed by their customers who pay via insurance. Why should the clinic change if improving results in almost no change to their compensation? This is why socialism, communism , etc. don’t really work and capitalism with its market functions does. Capitalism has an efficient pricing function that works vis-à-vis the free market. With no real pricing function, guess what? The have no incentive to change. Make that clinic self pay only and I guarantee they would either they find a bigger waiting room or they’d have less patients.” Well said. It is folly to expect people and organizations (even those involving sick people) to behave in any way that decreases their personal benefit. People and companies do what they are paid to do, and in the healthcare system we’ve designed, they are financially encouraged to pack the waiting rooms, overbill, overtreat, and otherwise milk the maximum profit possible from the healthcare abattoir (“immoral” isn’t nearly as much of a motivator as “illegal”). Blame those who designed the game, not those who play it skillfully. As PM notes, your insurance company is the practice’s customer, not you, and you can threaten to seek alternatives to either to see how little they care. Insurers and providers are well aware of how privately lucky you feel you are to have insurance and to get an appointment. There’s plenty more customers where you came from since healthcare creates its own demand.

From Edumacation: “Re: Betsy DeVos. She invested $1 million in Theranos, according to disclosure paperwork.” Education secretary nominee Ms. DeVos, whose family billions came from creating the Amway pyramid scheme of selling crappy beauty and nutrition products, perhaps earned an education of her own in sinking a micro-chunk of her family fortune in Theranos.

HIStalkapalooza Sponsor Profile

Since 1975, the Healthwise mission has been to help people make better health decisions. That mission, combined with our innovative spirit, results in health education, technology, and services that make every moment in care matter. By integrating our solutions into your existing workflows, we help you engage patients with consistent, evidence-based health information for improved outcomes, increased satisfaction, and lower costs. Visit us at HIMSS in booth #1523 and check out our demo stations for Point of Care, Care Coordination, Digital & Web Experiences, and Care Transformation. Find out more or schedule a one-on-one meeting at HIMSS at healthwise.org/himss17.

HIStalk Announcements and Requests

Thanks to the several readers who asked about offer of a free pass to the Healthcare IT Marketing and PR Conference in Las Vegas April 5-7. The quick-on-the-trigger CEO who asked about it first got the pass and promises to follow up with a write-up afterward. I had just the one pass to offer for free, but others can at least save $300 by registering using promo code “histalk.” Many of my sponsors came on board due to the efforts of PR and marketing advocates and I appreciate their support.

I’ve been reclaiming my online life by muting Facebook and Twitter connections who just can’t stop spouting political bitterness or extending unsolicited political opinion despite not having any obvious qualifications commensurate with their partisan zeal. I’m also tuning out folks who repeatedly link to biased or sensationalistic news sources, which I define as pretty much all of them other than the New York Times, Washington Post, NPR, The Wall Street Journal, ABC/CBS/NBC, and the news wires. We have happily and indulgently cocooned ourselves off from civic responsibility with niche TV channels, Netflix, and Facebook and thus are collectively not really capable any longer of courteous, informed discussion. The American formula of offsetting a shortage of factual knowledge with an excess of emotional conviction doesn’t generally work (notable exceptions exist). Calling someone stupid or evil just because they have different opinions seems pretty stupid and evil.

Webinars

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 

Acquisitions, Funding, Business, and Stock

GetWellNetwork acquires Seamless Medical Systems, which offers a patient check-in and waiting room solution.

Integration technology vendor Redox raises $9 million in a Series B funding round, increasing its total to $13 million.

The drug industry’s trade group launches a multi-million dollar, feel-good ad campaign in trying to position itself as a responsible contributor to societal health following a series of embarrassing price-gouging news stories, most recently involving Mylan’s EpiPen. The group’s CEO makes reference to, “less hoodie, more lab coats” in trying to distance itself from non-member companies and former Turing Pharmaceuticals CEO Martin Shkreli, who in response quickly created a “Pharma Skeletons” web page to highlight the pricing misdeeds and tax-dodging “relocations” to Ireland of some of the trade group’s members.

The Advisory Board Company returns responsibility for the maintenance and marketing of its Quality Compass infection surveillance and antimicrobial stewardship software to its original developer, Vecna Patient Solutions. Vecna offers patient access software but is probably best known for its VGo Telepresence robot. The Advisory Board Company announced the restructuring of its healthcare business three weeks ago, when it said that it will exit its still-profitable businesses of care management workflow, nursing workforce, and infection control analytics.

The Chan Zuckerberg Initiative will acquire Meta, an artificial intelligence-powered search engine for medical journal articles. The charity, founded by Facebook CEO Mark Zuckerberg and his wife Priscilla Chan, MD, will give researchers free access.

Sales

In Canada, 656-bed Humber River Hospital will upgrade to Meditech’s Web EHR.

Ballinger Memorial Hospital (TX) chooses CPSI’s Evident EHR.

Announcements and Implementations

Ability Network announces its FHIR-based API program that allows partners (clearinghouses, payers, RCM companies, and EHR vendors) to connect to its platform for eligibility lookups, claim submission, and acknowledgement and remittance download.

DirectTrust says that 98 million Direct messages were exchanged in 2016, with the number of Direct-issued addresses increasing 24 percent in the year.

Government and Politics

Former Acting CMS Administrator Andy Slavitt warns that replacement plans for the ACA often label condition exclusions as “patient choice,” highlighting this just-passed Minnesota proposal that allows insurers to sell policies that exclude coverage for cancer, emergency services, diabetes, and outpatient services. Sponsor Rep. Steve Drazkowski (R-Mazeppa) says the plan he championed is “a cure for the regulatory disease” that allows insurers to offer a la carte coverage that doesn’t include all 68 federal mandates. Critics ask the logical question – what crystal ball should consumers consult in buying plans that don’t cover yet-unknown but horrendously expensive conditions? Long-timers will recall when well-intentioned patients would present “insurance cards” pretty much like these policies — they covered basically nothing since they were ridiculous voluntary discount membership cards they bought from late-night TV infomercials in confusing them with being insured.

Here’s something to ponder – if marketplace plans go away, a lot of solo creative people who contribute to the economy (authors, musicians, entrepreneurs who are building companies) will either go back to being uninsured or will have to return to full-time jobs to earn the privilege of paying for health insurance. The ACA isn’t perfect, but making insurance available only to the employees of companies seems to discourage entrepreneurial pursuits that hold a lot more economic promise than chasing long-gone assembly line jobs. It’s a step backward if people have to remain underemployed because seeking better fortunes would preclude them from getting insurance that covers their existing medical conditions. I still recall the anguish of having to lay off a long-time hospital employee who had stuck with her not-so-great job only because she was uninsurable elsewhere because of breast cancer, and I still curse the name of the new VP who was so anxious to earn suck-up points with his executive peers that he got fooled into taking on her entire transferred team without a corresponding budget, thus getting the executioner duties turfed off on him by far more skilled but equally gutless players. He of course wasn’t available when security and I walked them off the property.

The Congressional Budget Office says the federal budget deficit and tepid economic growth will run the national debt up another $10 trillion in the next 10 years, much of that driven by healthcare and Social Security entitlement programs. CBO still says the economy is solid and job growth is imminent. The national debt stands at around $20 trillion, most of it held by investors. These numbers don’t take into account the $1 trillion infrastructure investment and tax cuts planned by the administration.

Technology

Health services in Norway are planning to move from Microsoft’s Windows Phone to Android because of high cost and low availability.

Cedars-Sinai chooses eight startups for the next class of its accelerator boot camp:

• Cerebro Solutions (labor management)
• Enso
• FIGS (medical apparel e-commerce sales)
• Frame Health (identifying non-adherent patients via personality analysis)
• Healthcare TTU (cash flow and AR analytics)
• HealthTensor (artificial intelligence)
• Noteworth (device interoperability)
• ReferralMD (referrals)

Other

In England, ongoing delays in implementing Cerner Millennium at Calderdale and Huddersfield NHS Foundation Trust have increased the expected cost from $6 million to $15 million. The overrun is due to the cost of backfilling the positions of clinicians assigned to the project and a harder-than-expected data migration from legacy systems.

In Australia, someone accidentally leaves a backup generator’s switch turned off, with its eventual failure during a power outage causing a hospital blackout that required evacuating ICU patients and that also destroyed its fertility center’s 50 frozen embryos.  

NIST publishes results of a perception and experience study on EHR copy-and-paste, but I’m not going to describe it since it involved a ridiculously small sample size (five nurses and four doctors), all of them using the military’s AHLTA system that’s already being replaced with Cerner. Basically the study supports previous recommendations that (a) text that has been copied and pasted should be clearly identified, and (b) EHRs should display the “chain of custody” of the information when the user wants to see it. As most studies fail to address, it doesn’t question why the EHR requires or desires information to be stored multiple times. My guess is that someone worries that it will be missed, so I’ll fall back to my usual recommendation that EHRs should allow every user to flag individual text as being important in their care decisions rather than just dumping massive amounts of text that must be mined by each clinician for anything relevant. I like the idea of a chart being treated like a long paper document where I could use a highlighter to mark just the important sections, then date and initial them for later lookup by me or by someone else (maybe I just want to see which parts the cardiologist found useful). EHRs were designed to force users to input discrete data elements, but that’s for the convenience of non-clinicians.

I’m fascinated that one of the hottest hospital-related debates in England has always been that hospitals charge for parking. A parking app vendor files a Freedom of Information request to determine that hospital visitors were fined $17 million in a single year. Thus evolved my latest can’t-miss money-making scheme: an independent offsite parking operation that shuttles visitors back and forth directly to hospital campus locations like an airport shuttle. I would never park in an airport garage – it’s silly to pay 3-4 times the cost of an offsite shuttle that will drop me and my bags directly at the gate instead of leaving me to drag my stuff through a poorly lit garage where I have to remember where I parked. I would be equally unlikely to choose hospital garage or valet parking given a low-friction alternative.

Sponsor Updates

• Obix by Clinical Computer Systems posts a video covering its implementation at Yoakum Community Hospital (TX).
• Besler Consulting releases a new podcast, “The Future of MACRA in 2017.”
• Biz Journals includes Caradigm President and CEO Neil Singh in its list of “New Seattle-area CEOs of 2016.”
• CenterX will exhibit at the NCPDP Workgroup Meeting February 1-3 in San Antonio.

Blog Posts

• Understanding MACRA – Are You Eligible? (Optimum Healthcare IT)
• ACO Participation Associated with Improvements in HACs (Definitive Healthcare)
• A Look into 2017: New Administration and OCR Audits (AdvancedMD)
• What’s the Value of a $71,838 EOB for a Hip Replacement? (Arcadia Healthcare Solutions)
• Achieving Real-Time Respiratory Depression Surveillance of Post-Surgical and PCA Patients (Bernoulli)
• The CMIO Role in the Era of Value-Based Care (Catalyze)
• Big Changes with the 21st Century Cures Act (CareSync)
• 5 Tips for Submitting the Best PA Request for Your Patient (CoverMyMeds)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

Morning Headlines 1/24/17

Judge Blocks Aetna’s $37 Billion Deal for Humana

A federal judge has sided with the Justice Department in blocking the proposed $37 billion merger between Aetna and Humana on antitrust grounds.

Cybersecurity Framework Draft Version 1.1

NIST releases a draft update to its Framework for Improving Critical Infrastructure Cybersecurity.

Drug industry unveils massive new campaign to counter criticism

A pharma industry lobbying group has launched a new ad campaign designed to move the industry past recent price gouging stories that have consumed media attention recently. The lobbying group’s president backhandedly calls out Martin Shkreli in describing the campaign as an effort to portray  “Less hoodie, more lab coats” . In response, Shkreli publishes a list of price gouging activities that the pharmaceutical companies funding the campaign have engaged in.

Next Generation ACO Model

CMS reports that 45 ACOs are now participating in its Next Generation model.

Curbside Consult with Dr. Jayne 1/23/17

I wrote last week about a real-world curbside consult from my IT colleague, Jimmy the Greek. As promised, here is the second installment of Dr. Jayne’s Journal Club, where we will continue with our patient case presentation.

When we last left Jimmy, he had been referred from the physiatrist to an orthopedic surgeon. I didn’t go into detail about insurance or how much this has been costing him, but since it’s a new year, I’m betting he’s facing a new (and most likely daunting) deductible. When I was a CMIO at Big Health System, we always saw a dip in business during the first month of the year, but things picked up in February as people met their deductibles. I don’t have access to that kind of performance data any more, but I wonder what those curves look like given the expansion of high deductible plans.

At the end of my last piece, I had just made an appointment to review my MRI results with Dr. Professional himself. I arrived at the appointed time (15 minutes prior to the appointed time, actually) and after I explained why I was there, I received a terse “ID and insurance card” along with the outstretched hand of the front desk attendant (who, for reasons unbeknownst to this author, was the only one in the office wearing scrubs.)

After a considerable wait, I was shown to an exam room, where I met a physical terrorist … err, therapist. She took down the same history I had provided the doctor in previous visits, so either my records weren’t updated or she didn’t bother to read them. Finally, the doc comes in and pulls me out into the hall, where he has my MRI results pulled up. Yep, in the hallway, where anyone walking by can take a look. So much for HIPAA.

Dr. Professional explains that he sees some osteoarthritis and he wants me to consult with an orthopedic surgeon to see about laparoscopic surgery. I’m given a referral and sent on my merry way.

A friend of mine is an orthopedic surgical nurse at Big Hospital System, so I asked her about the guy who might shove soda straws into my hip joint (Yes, I watched the YouTube video. Yes, I now know I should not have done that.) She asks around and comes back with a consensus from the docs she asked: “He’s competent.” Not exactly a ringing endorsement, but I’m planning on a second opinion anyway, so I set up an appointment to see Dr. Competent.

Being a savvy healthcare consumer, I obtained Dr. Competent’s new patient forms from his practice website, printed them, and filled them out ahead of time. Confidential to all of you CMIOs and practice managers out there – fillable PDFs are a thing now, and if you don’t have them available for patients, you should. If you can’t figure out how to do it, I’ll do it for you – contact me through Dr. Jayne. I promise my rates are as reasonable as the amount of time I spend in your waiting rooms.

Upon arrival at Dr. Competent’s MegaOrthoMart Practice, I handed in my homework, forked over my ID and insurance card, and was promptly handed two additional forms to fill out, which requested much of the same information that I had provided on the phone when making the appointment and on the forms I filled out ahead of time. Then I got to wait until a registrar became available, and she more or less walked through the forms and asked me if each line item was correct. It’s now 35 minutes past my 8 a.m. appointment time and I’m still stuck in the lobby.

Someone finally comes to get me and the first thing they want to do is take x-rays. Remember the last installment? I’ve had x-rays and an MRI. Despite the fact that I brought the imagery with me, MegaOrtho insisted on doing their own because they “can’t be certain of the technique used to obtain [my] existing films.” I tend to believe the real reason they wanted to take more x-rays was more along the lines of, “This way we can bill your insurance company for more services.” When I get my explanation of benefits, I’m sure I’ll see an office visit from Dr. Competent, a facility fee from MegaOrtho, and imaging fees from MegaRadiology. At least MegaOrtho is independent and not part of Big Hospital System or they would be after their piece of the pie, too.

At 9:15 AM (a full 75 minutes past my appointment time), I finally get to see Dr. Competent in all of his frat-boy glory. Without introducing himself (what is it with doctors just assuming you know who they are?), he proceeds to explain what’s wrong, explains that surgery is an option, but a cortisone shot and physical would be a better first step. I’m all set to get the cortisone done, but he explains that he doesn’t do that for Dr. Professional’s patients. So now I get to make another appointment with him for an ultrasound-guided cortisone injection.

At this rate, I’m going to need to take a second job just to fund my co-pay habit (see “fillable PDF” offer above). The cynical part of me can’t help thinking that this is just a scheme to extract as much money from me and my poor, innocent insurance company as possible. I don’t begrudge anyone the ability to make a living, but this just seems excessive. (For those of you keeping track at home, we’re up to three appointments with Dr. Professional now.)

The one bright spot in this adventure has been the staff at the physical therapy place. Everyone there is friendly and efficient. Here’s to a speedy recovery and success in physical therapy. If I have to have the hip scoped it, it’s a longer recovery than I’d like, so keep those patient information forms coming my way; I’ll apparently have lots of time on my hands to create fillable PDFs.

Looking at this entire saga through my CMIO lens, the element of the story that strikes me most is the fact that we’ve spent billions of dollars trying to make healthcare better and we still haven’t solved the basic problems that patients face. Let’s look at customer service. In some situations, customer services has gotten worse as front desk staff are under increased pressure to ensure collections. Staff members are also encouraged to maximize throughput even if it doesn’t make sense and patients are filling out duplicative information. We haven’t mastered basic technology such as fillable online forms and practices are often reluctant to fully leverage patient portals, especially to collect information on new patients.

We still have clinicians who are too busy to read (or don’t trust) the history in front of them, so they ask redundant questions. We haven’t spent money transforming our office spaces to increase patient privacy or comfort and still show images in the hallway. Despite the advent of provider ratings and online reviews, patients still have limited information to judge a physician’s competency. We’ve also pushed providers and health organizations to the edge of financial viability, leading to increased reliance on provider-based billing and facility fees to get as much money out of the system as possible.

Despite the ability to exchange data or having images on CD in front of us, we repeat testing because we don’t trust our peers or are too pressed for time to look at the films before we decide whether the outside radiology group’s technique was adequate. Or maybe we’re just after the money. We have handshake professional agreements where a consultant doesn’t provide a service to a patient when he could, and instead sends the patient for another visit to the referring provider (and another co-pay and another day off work). I hope our patient’s cortisone injection and physical therapy does the trick because I would hate to see him panhandling for contract PDF work outside the next medical staff meeting.

Unfortunately, the continued push for more use of EHR technology and more metrics and more data points isn’t going to change human behavior. It seems like it’s getting harder to find organizations willing to spend money on the so-called “soft skills” or on truly transforming healthcare. They’re too busy trying to figure out how not to be penalized or worrying about when their vendor is going to release the next version of Certified EHR Technology.

What’s the answer to making healthcare something we can be proud of? Email me.

Email Dr. Jayne.

Morning Headlines 1/23/17

Full text: Trump’s executive order on Obamacare

Following through on campaign trail promises, President Trump signs an executive order calling for HHS to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden” on providers, insurers, patients, or States.

Trump Executive Order On ACA: What It Won’t Do, What It Might Do, And When

Health Affairs’ Tim Jost weighs in on the impact President Trump’s executive order is expected to have.

HHS Acting Secretary Norris Cochran

HHS Acting Secretary and former National Coordinator Karen DeSalvo quietly leaves her position with the administration transition.

Monday Morning Update 1/23/17

Top News

President Trump follows through on his promise to begin dismantling the Affordable Care Act on his first day in office by signing an executive order Friday that directs HHS and other federal agencies to “ease the burden” in doing whatever they legally can to hamstring the ACA.

Executive orders are more of a policy-signaling device rather than an unchallenged change to laws, but HHS discretion and its choice of which ACA issues to defend in court could affect key ACA elements in halting the payment of insurance subsidies (which were never approved by Congress but are being paid by HHS anyway) and tinkering with hardship waiver requirements to effectively end the “individual mandate” that at least theoretically requires people to carry health insurance.

The executive order happens before “repeal and replace” begins in earnest, before a Trump-appointed HHS secretary is installed, and in the absence of a replacement plan for the program that insures 20 million people.  

Reader Comments

From Herd Tracker: “Re: HIMSS and overly intrusive marketing with their new Media Lab. Remember a couple of years ago when you wrote about how they were going to track the movement of conference attendees via a badge-implanted chip?” I remember clearly, although I assume HIMSS quietly backed away from that plan. HIMSS10 featured tracking of attendees via RFID badge so that exhibitors could “derive a more accurate score of a visitor’s buying potential,” logging attendee movements that included which booths they visited and for how long. I was obviously upset back then as a dues-paying member:

The conference keeps getting more similar to a cattle-butchering operation: you’re herded into a holding pen (the exhibit hall) since the token educational offerings (getting less useful every year) intentionally go dark during major booth hours. You’re fed and watered in the exhibit hall with vendor snacks until it’s your turn with the the high-paying exhibitors. Now you’ll be tracked like livestock throughout the process … I can imagine what was going through the minds of the HIMSS dim bulbs who approved this — hey, we can charge vendors even more by selling them the personal information of attendees … and HIMSS can justify its exorbitant exhibiting costs by showing who dropped by. People seemed to be resigned to letting HIMSS do whatever it wants in the name of picking the pockets of its vendor members … Being tracked as nothing more than a roving sales prospect is just insulting. HIMSS apparently doesn’t extend its claimed interest in patient privacy to its own paying customers in the Ladies Drink Free model in which it pimps access to low-paying providers to high-paying vendors.

From Privately Held: “Re: Epic. A private equity group called Capricorn Healthcare lists Epic as one of its holdings, which is surprising given Judy’s repeated statements about being employee-owned and not being acquired.” The PE firm lists Epic as a current holding, but doesn’t specify when or how much it invested.

HIStalk Announcements and Requests

One-third of poll respondents say their employer has cut expenses or reduced expectations due to ACA uncertainty.

New poll to your right or here: What is your reaction to HIMSS creating a conference and a division to help vendors sell to providers?

We funded the DonorsChoose grant request of Ms. R in New York, who asked for math manipulatives.

I like to root for the little guy, so when HIMSS announced its marketing conference last week, I immediately thought of the HITMC conference that John Lynn and Shahid Shah have been putting on for a few years and wanted to help them out (unlike HIMSS, not only do they have no conflict of interest, they also came up with the idea first). HITMC17 is the networking and educational event for those in healthcare marketing and PR, featuring 30 presenters who will cover topics such as social media, brand advocates, online reputation, marketing automation, email marketing, branding, SEO, and content strategy. HITMC will be held at the SLS Las Vegas April 5-7, 2017 and promo code “histalk” will save you $300 on registration. I may ask Lorre or Jenn attend to help us understand how health IT marketing works (I’m a fan of marketing done the right way, but I confess that delight when it’s done hilariously badly). We’ll probably use only one of the two passes John has graciously offered us, so if you want to attend and are willing to write up what you liked and learned afterward in a short HIStalk article, email me and I might give you a free pass.

Listening: One OK Rock, a Tokyo-based foursome of 20-somethings that play hard if not terribly original alt-rock. It’s a bit intentionally boy-bandy at times, but at least it’s different than most of the chart junk.

Last Week’s Most Interesting News

• The Wall Street Journal discovers that a Theranos lab had failed a surprise CMS inspection right before the company announced that it would exit the testing business.
• The Coordinated Care Oklahoma HIE announces that it will shut down.
• HIMSS announces a healthcare IT marketing conference and a new arm that will use the HIMSS database to more aggressively market the offerings of paying vendors.
• Surgeon-author Atul Gawande, MD admits in a New Yorker article that he has undervalued the health contributions of PCPs that he calls “incrementalists” compared to the decisively curative but less-impactful work of surgeons.
• The Supreme Court agrees to review the use of arbitration agreements to prevent employees from filing labor-related class action lawsuits, with Epic Systems being one of the handful of companies asking for a definitive ruling.

Webinars

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 

Decisions

• Long Island Jewish Valley Stream (NY) went live with Kit Check medication tracking in December 2016.

These provider-reported updates are provided by Definitive Healthcare, which offers powerful intelligence on hospitals, physicians, and healthcare providers.

Government and Politics

As I expected but haven’t seen mentioned anywhere, HHS Acting Assistant Secretary for Health and former National Coordinator Karen DeSalvo, MD, MPH has apparently left her role with the administration change based on updated HHS web pages. Principal Deputy Assistant Secretary for Health Jewell Mullen, MD, MPH, MPA is listed as having taken over the Acting Assistant Secretary role. DeSalvo, who stepped down as National Coordinator in August 2016, hasn’t mentioned her departure or plans on Twitter.

Privacy and Security

From DataBreaches.net:

• TriHealth (OH) blames a software problem for sending the information of 1,126 patients to their previous address.
• An appeals court rules that people whose information was stored on a stolen laptop can sue Horizon BCBS for violations of the Fair Credit Reporting Act even though they suffered no negative consequences.

Other

Billboard profiles our amazing HIStalkapalooza band Party on the Moon and its longstanding New Year’s Eve gig playing for now-President Donald Trump. It describes their first time playing the Mar-a-Lago event, where they were noodling through harmless dinner music like “The Girl from Ipanema,” when the boss’s assistant passed along his request: “Mr. Trump would like you to stop playing this crap and play something more upbeat.” I was skeptical about hiring a cover band for HIStalkapalooza, but it’s hard to describe their stage-filling show – they play with remarkable skill and enthusiasm. the music never stops for a second, and they literally from their first note pack the dance floor with HIStalk readers who admit that they never dance otherwise.

Sponsor Updates

Blog Posts

• Mitigating Hybrid Cloud Security Risks (Tierpoint)
• Tips to drive your population health journey and avoid the potholes (Verscend)
• Thinking of Eliminating the Waiting Room? (Versus Technology)
• Avoid buyer’s remorse: Look beyond basic texting apps. (Voalte)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

Morning Headlines 1/20/17

Tim Draper keeps defending Theranos

Despite exhaustive examples of corporate irresponsibility and ineptitude, early Theranos investor Tim Draper continues to defend the company, calling the unrelenting bad press a conspiracy to take down Elizabeth Holmes.

The Final Days of Obama’s Tech Surge

As the Obama administration winds down, speculation over the future of the United States Digital Service mounts. The group, made up of high-profile Silicon Valley tech minds, was launched to rescue Healthcare.gov and help transform the government with technology.

CBO Scoring: The Issue Is Not How It’s Done, But How It’s Used

Health Affairs explains the role of the Congressional Budget Office in the overall legislative process, and outlines CBO cost estimates associated with repealing ACA. The article also notes that House rules were recently passed that contain a provision forbidding the CBO from generating long-term estimates on the impact of repealing ACA.

HIMSS Media Lab is Launched to Lift Audience Engagement and Revenue

HIMSS acknowledges that it will begin selling member data to support vendor sales efforts, explaining “We’re leveraging the HIMSS database of over one million health and technology experts…This enables us to identify the emotional and business triggers…and that’s really the key to understanding buying intent.”

News 1/20/17

Top News

Theranos announced in October 2016 that it would close all of its testing labs, but the Wall Street Journal finds that Theranos didn’t mention at that time that its Arizona lab had failed an unannounced CMS inspection several days earlier.

Meanwhile, Theranos investor and friend of CEO Elizabeth Holmes Tim Draper still maintains that Holmes is a victim of a Wall Street Journal vendetta, claiming that, “the guy is getting $4 million to continue this charade,” referring to the book and movie deal signed by WSJ reporter John Carreyrou, who Draper calls a “mouthpiece” for Theranos competitors.

Draper says big lab companies, drug companies, and insurers don’t like the idea of people taking control of their health and competing with a company selling tests for less. He adds that even though Theranos admitted that some of its lab results were unreliable, “I like that they’re self-policing.”

Reader Comments

From I See Light: “Re: HIStalkapalooza. HIMSS … what a freak show of excessive marketing budgets. At least there is HIStalkapalooza to set one’s mind right!  Listening suggestion: Pet Clinic, from my adopted hometown of Pittsburgh.” I’m listening to Pet Clinic on Spotify now and am struck by how much they sound like Frank Black and the Catholics at times, especially the singer’s phrasing. I’m also reminded of how much I like the Dirty O’s fries, although it’s hard to understand why their hundreds of available beers don’t include Iron City, often pronounced “Ahrn City” in the ‘Burgh, at least by those who still care now that its blue collar heyday is long past and it has moved out of town.

HIStalk Announcements and Requests

We funded the DonorsChoose grant request of Ms. L from Michigan, who asked for a portable PA system so the class could easily hear her and students who are presenting their work. I was touched by her description of the impact made by a few dozen of our donation dollars:

Just today a student told me that he loves it when I wear the microphone because then he knows I am about to "say something important" and he can shift to listening mode. Another student wanted to write and perform a rap song for you but I did not have a way to upload video so he settled on writing a poem. You’ll see it in the pictures. He hopes you enjoy it. But surely my favorite was when one student saw and heard the mic for the first time and declared, "Ms. Lab, you’re crispy." You’ve made the impossible happen: fifty-eight years old and crispy! Kudos! This technology has allowed me to speak to my students and be assured that every student has an opportunity to hear instruction. Another benefit: I no longer leave work at night with a strained voice!

This week on HIStalk Practice: MDlive ups its employer offerings. UnitedAg expands relationship with Teladoc. Essex County Mental Health Services goes with TenEleven HIT. United Medical Laboratories connects to physician EHRs. AccentHealth’s Sara Johnston advocates for digital point-of-care education during flu season. Aprima acquires Healthcare Data Solutions. Oculus Health raises funds for further CCM, CPC+ offerings. Modernizing Medicine’s Mandy Long attempts to make MIPS a little less fear-inducing.

Webinars

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 

Acquisitions, Funding, Business, and Stock

Aprima acquires Coral Gables, FL-based EHR/PM reseller Healthcare Data Solutions.

Spok will add 60 positions at its Eden Prairie, MN office.

Athenahealth’s accelerator invests an unspecified amount in The Right Place, which helps hospitals place patients in SNF beds. The company had previously raised $2 million in a single October 2015 seed round.

Sales

Phelps Memorial Health Center (NE) selects Parallon Technology Solutions as implementation partner for its Meditech 6.1 upgrade and expansion.

BJC HealthCare (MO) chooses MModal for speech recognition and clinical documentation improvement as it transitions from NextGen and Allscripts to Epic.

People

Philips hires Roy Smythe, MD (Valence Health, HX360) as chief medical officer for health informatics.

Allscripts hires Lisa Khorey (EY) for the newly created position of EVP/chief client delivery officer and Alan Fowles (Nuance) as president of Allscripts International.

Next Wave Health Advisors, a Huntzinger Management Group company, hires Greg Walton (El Camino Hospital) as an advisor.

Announcements and Implementations

Coordinated Care Oklahoma will shut down following the requirement of an unnamed payer that providers submit their data to a competing HIE. CCO announced in June 2016 that it was the first Cerner-powered HIE to connect to the DoD. We interviewed CCO Chief Administrator Brian Yeaman, MD a couple of months ago, who gave no hint that the wind-down was imminent.

Government and Politics

A Backchannel article profiles the successes and uncertain future of the US Digital Service, created by tech-savvy President Obama, spearheaded by Todd Park, and enlisted to save Healthcare.gov but now wondering whether the Trump administration will keep the program. It’s a good article, although obvious election results bitterness makes it less effective (referring to the incoming President by last name only, slipping in smug put-downs, and ending with “God help us all” make it clear that the author doesn’t mind turning a nice feature into yet another ugly personal editorial). Here’s a snip of the less-whiny part:

Then came October 2013, when technology — once supposed to be an Obama strength — almost took down his administration. The signature legislation of his presidency, the Affordable Care Act, depended on a website that matched individuals to health insurers. It was a thermonuclear failure. When Park swooped into the situation with some of his PIF team, he realized that the only solution was to tap outside talent. Drawing on connections to the Obama campaign’s digital warriors and Silicon Valley companies, Park tapped a very small group of great coders and developers to rebuild in weeks, on the fly, what $500 million worth of contractors and government employees couldn’t do. In fact, an expensive, mishandled disaster was almost routine for government IT, where overpaid contractors with little oversight used outdated processes to work with jaded government workers. But this time the lifers had to cooperate. “The message that they got loud and clear from the White House was, This is bad enough that none of you is getting out of this alive,” Mikey Dickerson, a former Google engineer who led the team, later recalls. “Your only way out is if you get your act together and make the site work.”

CMS gives hospitals a couple of extra weeks to submit their eCQM data for the FY2018 EHR incentive program, extending the reporting deadline to March 13, 2017.

A Health Affairs blog addresses the Congressional Budget Office’s estimates of the effects of ACA repeal, noting that House rules implemented on January 3, 2017 specifically prohibit CBO from talking about the effects of ACA changes. The article says, “Congress has thus placed itself in the position of appearing to prefer no information at all to information that might conflict with its political objectives.” Recent CBO estimates that ACA repeal would cause 32 million more citizens to lose insurance and that premiums will jump 25 percent in the first year were based on a study that was performed before the ban.

Maryland-based Evergreen Health Cooperative – one of the last ACA-authorized, CMS-funded insurance co-ops that hasn’t gone belly up – converts itself to a for-profit, investor-owned insurance company.

Massachusetts plans to cap provider price growth rates and charge employers who don’t offer health insurance $2,000 per full-time employee. The state’s budget is getting hit hard by Medicaid enrollment that will grow to nearly 2 million in 2017 as full-time workers skip employer-provided coverage to take advantage of federal subsidies. The state’s previous universal coverage plan required employers to offer insurance and prohibited insurance-eligible employees from buying MassHealth coverage, but both requirements were eliminated with passage of the ACA.

CMS Chief Medical Officer Patrick Conway, MD of the CMS Innovation Center will serve as acting CMS administrator with the administration change starting January 20 pending the Senate’s approval of Seema Verma. He replaces Andy Slavitt.

Privacy and Security

MAPFRE Life Insurance Company of Puerto Rico pays $2.2 million to settle HIPAA charges involving the 2011 theft of an unencrypted flash drive from its IT department that stored the information of 2,209 customers. MAPFRE also failed to follow through on correct measures assigned by OCR. The HHS announcement suggests that it scaled the settlement to the size of the multi-national company rather than the extent of disclosed information, which is an interesting way to assess penalties.

The daughter-in-law of a man who died 2014 says she was billed for new surgical procedures in the fall of 2016 by a specialty practice owned by Sentara, which recently announced that 5,400 of its patient records were exposed in a breach of one of its contractors.

Innovation and Research

An interesting New York Times article notes the startling finding by The Johns Hopkins Hospital that fewer female patients were receiving blood clot prevention treatment than male patients, leading the hospital to develop a computerized decision support system that collects information at admission and recommends treatment, taking human bias and subjectivity out of the equation.

Other

What a difference a domain makes: insurance shopping site Healthcare.com connected 2 million people with insurance brokers in 2016, all of whom confused it with the official Healthcare.gov.

A study with a ton of flaws (old data, small sample size, lack of analysis to determine the appropriateness of ordering, failing to account for the demographic difference in non-EHR practices) suggests that doctors who use EHRs order more diagnostic imaging and laboratory tests than those who don’t.

Drug maker Mallinckrodt will pay a $100 million Federal Trade Commission fine for jacking up the price of H.P. Acthar Gel from $40 per vial to $34,000 and for blocking competition by outbidding another drug company for a similar drug. The company’s predecessor was an early dodger of US taxes in taking an Ireland tax address instead of St. Louis, reducing its taxes by more than half. Most its actions, however unsavory, were legal.  

A medical resident’s New York Times opinion piece warns that the volunteer army of people who care for their older relatives is stretched too thin due to longer life expectancy, more complex medical care, smaller family sizes, and greater geographic separation. The current ratio of seven potential family caregivers for each person over 80 will drop to three-to-one by 2050 with the resulting loss of income as they either leave their jobs or work fewer paid hours to focus on attending to their family member’s needs. The author suggests that doctors list family caregivers in the medical record, include them in decision-making, and train them to perform medical tasks.

HIMSS finally acknowledges creation of its Media Lab that will “leverage the HIMSS database of over one million health and technology experts as our laboratory” to “lift audience engagement and revenue.” The Media Lab will use your personal information to “identify the emotional and business triggers” that will help it sell advertising-driven webinars, videos, and conferences to vendors. ”We know what information they [meaning you] consume,” HIMSS brags in describing members like a scientist talking about lab rats and highlighting that whatever “news” it produces should be taken with a grain of salt. The announcement adds, “Many healthcare IT vendors are struggling,” failing to mention that maybe the failing ones could use better products or leadership instead of more aggressive marketing. Every time I think HIMSS can’t possibly do anything more commercial or member-intruding in chasing vendor dollars, they prove me wrong (imagine the Salvation Army or Doctors Without Borders selling marketing advice and leads). As you might expect, the lengthy roster of the Media Lab people includes basically nobody with any education or background in healthcare or technology – their life’s work is to push whatever widgets they’re paid to promote. HIMSS Media runs the Privacy & Security Forum, so perhaps that’s a good venue in which to consider the privacy implications of selling member data to advertiser-stalkers. I wish I had Photoshop skills so I could superimpose Steve Lieber’s head onto that of Alec “Always Be Closing” Baldwin in the “Glengarry Glen Ross” shots above featuring “the good leads,” as HIMSS envisions those of us who pay dues and conference registrations.

West Virginia Public Radio notes that the one bright spot in a state ravaged by drugs and unemployment is WVU Medicine, which thanks to the Affordable Care Act’s $12 million boost to its bottom line has been able to build new buildings and hire more than 2,000 people last year. The health system is the state’s largest employer and its flagship hospital runs at 98 percent capacity, with the CEO saying, “There’s almost an insatiable appetite for everything we do.” That’s good news for everyone except us federal taxpayers footing most of the bill. The health system’s 15,000 employees mean that nearly 1 percent of the state’s declining population works there.

A study finds that around-the-clock hospital chaos can cause and accelerate dementia in elderly patients that can ultimately kill them.

Sponsor Updates

• Kyruus adds two physicians to its clinical advisory board.
• Ivenix will demonstrate the integration of its Infusion Management System with EHRs and alarm management systems at the HIMSS17 Interoperability Showcase.
• The Red Hot Healthcare podcast features Medicity’s Brian Ahier.
• Optimum Healthcare IT publishes a new case study, “Security Remediation at a Large Academic Medical Center.”
• NCQA certifies ZeOmega’s Jiva for five HEDIS 2017 measures.
• Fortune ranks Health Catalyst one of the 30 best workplaces in the US technology industry.
• GetWellNetwork’s All-In-One PatientLife Console achieves Electronic Product Environmental Assessment Tool certification.
• InstaMed and PatientMatters will exhibit at the HFMA Mid-South Institute January 25-27 in Memphis, TN.
• InterSystems will exhibit at the CIO Exchange January 22-24 in Orlando.
• Intelligent Medical Objects will exhibit at the Allscripts 2017 South ARUG January 21-22 in Raleigh, NC.
• TransUnion publishes a new white paper, “Money talks: Rethinking what it means to put patients first.”
• MedData will exhibit at the American Society for Anesthesiologists Practice Management event January 27-29 in Grapevine, TX.
• Meditech will exhibit at the 50th MHA Annual Mid-Winter Leadership Forum January 27 in Framingham, MA.
• NTT Data team members support local children in need by volunteering at Cradles to Crayons.
• Obix Perinatal Data System will exhibit at the SMFM Annual Pregnancy Meeting January 25-27 in Las Vegas.
• Experian Health will present at the HFMA LA Women in Healthcare Luncheon January 24 in Baton Rouge.
• Phynd will exhibit at the North Carolina Epic Users Group Meeting February 8-9 in Greensboro.

Blog Posts

• 2017: What Lies Ahead for Healthcare IT? (Iatric)
• Change Is Right Around the Corner (Access)
• Tools of the Data Breach Trade: How to Keep Your Customers and Your Credibility in 2017 (ID Experts)
• ICD-10 Issue and its Impact on CMS PQRS Penalties (Impact Advisors)
• The Impact of Cyber-Attacks, and how Healthcare Organizations can protect themselves (Imprivata)
• Defining Personalization for Healthcare Marketing (Influence Health)
• Effective Leadership: What Today’s Healthcare CISO Can Learn From the Inaugural Addresses of Former US Presidents (InstaMed)
• MedData and the Coming Changes to the Affordable Care Act (MedData)
• What’s the Missing Link in Your Revenue Cycle Management Strategy? (Navicure)
• Integrating Care: Moving Beyond Interoperability to True Collaboration, Part II (Netsmart)
• A Word of Healthcare Wisdom, from the Crowd (Orion Health)
• Transition in Washington – and in Health IT (PatientKeeper)
• Optimize rapid response team efforts with automated, real-time communication (PerfectServe)
• Capturing the Complexities Around Chronic Illness (PMD)
• Reducing COB Denials to Accelerate Cash (Sagacious Consultants)
• Health Information Exchange – as an Entity and a Means of Communication (part 1 of 3) (Summit Healthcare)
• As Providers Embrace Connectivity, Surescripts Helps Them Access Millions of Patient Records in Real-Time (Surescripts)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 1/19/17

CMS announced today that over 359,000 providers are confirmed for four CMS Alternative Payment Models in 2017. This includes over 2,800 primary care practices participating in the Comprehensive Primary Care Plus initiative.

Although CMS is celebrating this as a victory for improved quality and reduced costs, there are a couple of things to note about the numbers. First, CPC+ was originally opened for up to 5,000 practices and CMS recently expanded that to 5,500. The cohort is barely over half full, which could mean a couple of things.

First, it could mean that practices aren’t exactly clamoring to participate in these models, which require more documentation and increased compliance requirements in exchange for higher payments. Practices might be nervous that they can’t recover the increased outlay needed to participate. Second, it could mean that practices applied but weren’t qualified to move forward, which would be a sad commentary on the state of value-based care transformation. One would expect that at this stage in the game they’d be able to do better than half capacity.

The Medicare and Medicaid EHR Incentive Program attestation website is open for business. Participants have until the end of the day February 28 to attest to Medicare 2016 program requirements. State deadlines for Medicaid programs vary. There are plenty of resources out there and a handy dandy Attestation User Guide that I wish more of my prospective clients would read before they call me. It outlines the process in gory detail with lots of screenshots and answers a good number of the questions I frequently receive.

Lots of chatter around the physician lounge about Atul Gawande’s recent piece. His premise, that the US health system rewards “heroic” care at the expense “incremental” care is an issue that I’ve written about in the past. We’re always looking for the newest, most high-tech interventions, but we neglect to really advocate for (or fully fund) things like public health, disease prevention, cancer screening, and more. It’s not glamorous to sit in an exam room and have the same discussions over and over with patients about weight loss, smoking cessation, moderation in diet, and increased activity.

Gawande lays it out like it is: “As an American surgeon, I have a battalion of people and millions of dollars of equipment on hand when I arrive in my operating room. Incrementalists are lucky if they can hire a nurse.” That’s the unfortunate reality for many primary care and non-procedural specialists in our healthcare system. Technology and incentive programs are supposed to help us better manage patients and level the playing field, but for some physicians, it’s too little, too late. Two more of my favorite physicians retired at the end of the year and I think we’re going to continue to see attrition in the generalist ranks.

The biggest chatter, though, has of course been about the upcoming inauguration and the pending repeal of the Affordable Care Act. One rumor making the rounds is that MACRA will also be repealed, which is an entirely different situation. It doesn’t help that plenty of people don’t understand the difference between the two, which adds to the confusion. Patients are also extremely worried about the potential loss of insurance coverage and increased premiums, regardless of whether their coverage is through employers or individual purchase.

The HIMSS17 invitations have started rolling in, but I happened across the Salesforce Trailblazer Party at BB King’s Blues Club on Tuesday night. I’m guessing I might be out of touch with some pop culture phenomenon, but I’m not following what is going on with the character in scrubs with mittens and an animal suit. There are also plenty of one-off marketing emails coming in. Pro tip: please make liberal use of spell check and grammar check. The plural of customer is “customers” not “customer’s.” Don’t just say you’re revolutionary – tell me why and what you do.

An informatics colleague handed me an article about the new Forward clinic in San Francisco. They’re advertising “AI and doctors working together to better manage your health.” Billing it as a “Health membership” they charge $1,800 a year, which they cleverly market as “$149/month billed annually.” Although they say they have a world-class medical staff, I didn’t see any names listed on the website. They do have a body scanner to give a “rapid picture of overall health.” One article about the practice has some interesting premises. It talks about the ability to re-engineer the user experience at the physician office. One example is a “hidden alcove for urine samples in the bathroom, and no need for an embarrassing walk down the hall.” Many physician offices (especially those that perform a lot of urine testing) already had those, so not revolutionary.

It also mentions the body scanner: “a machine that takes a few cents of electricity to run replaces the traditional 20-minute examination for blood pressure, heart rate, and other vital signs.” I hate to tell the Silicon Valley folks, but if 20 minutes was their baseline, that’s terrible. Very few primary care physicians (at least those of us working on the hamster wheel) would tolerate a staffer that took 20 minutes to perform basic patient intake. The efficiency nut has already been cracked by vital signs monitors that integrate to the EHR and smart beds that perform weight when the patient sits down. The article does include a comment from a physician and former venture capitalist who notes that the complexity of the healthcare market is often underestimated and I would tend to agree.

Another article mentions that “people with longer term issues such as obesity, high blood pressure, or skin problems will go home with sensors that can transmit data back to Forward.” I get the obesity and blood pressure hook, but skin problems? What are they sensing? And is it evidence-based? Has it been peer reviewed or approved by the FDA? Or is it digital snake oil? Health policy expert Paul Ginsberg is cited in the piece and notes the risk of unnecessary tests being triggered by use of sensors: “The notion of scanning people who don’t have a problem has been very solidly dismissed by the medical profession for a while.”

What do you think of Forward? Email me.

Email Dr. Jayne.

Morning Headlines 1/19/17

CMS announces extension of 2016 reporting deadline and intends to modify 2017 requirements

CMS notifies eligible hospitals participating in Meaningful Use that the deadline for submitting eCQM data for the 2016 reporting period has been moved from February 28 to March 13 and reports that additional changes are being considered to further ease reporting burdens.

Using the Electronic Health Record to Understand and Minimize Overuse

A JAMA article suggests that EHRs will deliver value by helping identify and minimize unnecessary, low-value care which the authors say accounts for “substantial health care expenditures and may cause harm.”

Theranos just made another major leadership change

Just prior to news broke that Theranos failed a second CMS inspection at one of its blood testing labs, the company announced a new advisory board that will focus on technology.

Trump HHS pick Tom Price faces Senate questioning on Obamacare, stock buys

Representative Tom Price, MD, President-elect Trumps pick to lead HHS, faces questions before the Senate HELP committee.

CIO Unplugged 1/18/17

The views and opinions expressed are mine personally and are not necessarily representative of current or former employers.

Baking with Oma

Oma — my mom and the grandmother of my kids — was dying a slow death at the hands of ovarian cancer. While cruel, it allowed us four years to say goodbye. Often life ends suddenly and you never get a chance to say goodbye. We had a long farewell. I wrote extensively about Oma’s influence on my career in 2010.

Growing up, Oma used November to bake. She baked thousands of German Christmas cookies for family and select friends. Under the cover of darkness (or so it seemed), Oma carefully placed the treasure of spitzbuben, haselnussmakronen, and weihnachtsplätzchen in large tins in the cool, dry utility room. They were sealed until the first advent of Christmas.

Through the Advent season, we sang carols, read scripture, and lit the candles on the Advent wreath. With the spice of mulled cider in the air, Oma distributed plates full of cookies to each of us kids, and to Opa — if he behaved. Christmastime was near, which also meant it was time for cookie trading. Cookies displaced dollars as currency during the holidays.

When Oma took ill, something nudged me to carry on the German Christmas cookie-baking tradition to honor her and keep our heritage alive.

The Christmas before her death, we flew Oma and Opa for a visit – and to bake. Oma baked from scratch and out of love, following secret family recipes that had been handed down through generations. With my kids, we dutifully watched and practiced the art of German Christmas cookie-baking with Oma.

Today, despite careful translation, calculations, and experimentation, our creations are not as tasty as Oma’s, but we remain determined. One of my sisters also continues the tradition and we now have annual cookie-tasting contests to see whose baking finesse is closest to Oma’s.

I cherished the times we baked with Oma and I know she loved to teach her kids and grandkids. I still can see our flour-covered aprons, smell the sugar and cinnamon melting in the oven, and hear the retelling of stories about previous generations and their baking escapades. Rat Pack Christmas records would play in the background and texts and phone calls would not interrupt us. We relished in the pure joy of togetherness and enjoyed laughter, silliness, and I confess, raw cookie dough.

This year, our baking tradition grew to include my two daughters plus the girlfriends of our youngest boys. There I was, like Oma years before, converting grams to ounces and reminiscing. Oldest daughter Talitha is now the baking matriarch and organized our novice bakers. Seven hours later, we had baked a dozen dozen German Christmas cookies. We even managed to bake some gluten-free cookies since we wanted to be politically correct.

Lessons learned baking with Oma:

• If you want to know people, you have to spend time with people. That’s pretty obvious, but ask yourself how many hours you spend with family or direct reports really getting to know them. My relationship with Oma grew exponentially after I left home because of the uninterrupted hours we were able to spend together being silly, doing things like baking cookies.
• Magic happens when you create together. Watching movies is fun and taking walks enables conversation and touch. But when you create together, it takes relationships to another dimension. While certain deliverables may take longer to create, I am increasingly amicable to working with others to develop presentations and other work products.
• Learning stimulates creativity. I am not averse to the kitchen, but I have never really enjoyed cooking. However, baking with Oma stimulated my creativity by forcing me to learn new things, such as how the mixture of various ingredients and the addition of heat can bring about change. I now recognize that there are many parallels between baking and many work activities that can lead to transformation and innovation.
• There is joy in cooking. It’s not so much the cooking that brings the joy, but the uninterrupted time spent with the ones you love. There is no joy in multitasking. I continue to struggle, but I am getting better at putting my phone away.
• Serving is good for the soul. Many of us don’t take the opportunity to serve enough. Baking cookies and sharing them is a simple act of service (though arguably it matters whether or not they taste good.) Delivering cookies you baked to friends and families is powerful. It reflects the money, time, and energy you poured into creating something for the benefit of others.
• Understand the workflow. There is no substitute for being there and walking the walk. Had Oma sent emails that we followed ingredient by ingredient, line by line, our cookies would have been OK. It was not until she was with us and we watched and emulated her, however, that we really understood. Understanding the workflow turned out to be the ultimate secret ingredient.
• Create memories that lead to legacies. Oma was absolutely the queen of cookie baking! The memories that my siblings and kids have of Oma are forever etched in our minds and we fondly retell our stories of German Christmas cookie-baking hundreds of times. Memories and legacies matter, as evidenced by my own family’s commitment to annual bake-offs to see whose cookies most closely emulate Oma’s. Consider what you are best known for in the workplace and decide if it’s the legacy you want to create.

I could continue with lessons learned, but these are the ones that quickly come to mind as I reflect on this past holiday season. The pictures and videos don’t do justice to the bonding that takes place when you take time to be in the moment and create with family, friends, and co-workers. Look for such opportunities in your daily life. I promise you won’t regret the time spent creating new memories.

Cookie, please.

Ed encourages your interaction by clicking the comments link below. He can be followed on LinkedIn, Facebook, Twitter, or on his web page.

Readers Write: Are You Ready for the Quality Payment Program?

Are You Ready for the Quality Payment Program?
By Kory Mertz

With the start of the New Year, the first performance period for the Quality Payment Program (QPP) has officially started. The QPP, part of the MACRA legislation, was passed with strong bipartisan support in Congress and sends a clear signal of the federal government’s accelerating effort to move to value-based payments.

QPP creates two new tracks for Eligible Clinicians (ECs), as program participants are called: the Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models Incentive Program.

MIPS

MIPS consolidates and sunsets three programs focused on ambulatory providers: the Physician Quality Reporting Program, the Value-Based Payment Modifier, and the Medicare EHR Incentive Program for eligible professionals. In 2017, ECs can receive a maximum payment adjustment of plus or minus 4 percent based on their performance in four categories. ECs who are new to Medicare or who bill less than $30,000 or see fewer than 100 Medicare beneficiaries during a year will be exempt from MIPS.

In response to significant feedback from the provider community, the Centers for Medicare and Medicaid Services (CMS) has simplified the requirements and made 2017 a transition year to help ECs get used to participating in MIPS. Providers have three general approaches they can take:

Alternative Payment Models Incentive Program

The second track of QPP is focused on increasing EC participation in Alternative Payment Models (APM) (i.e. Accountable Care Organizations, bundled payments, etc.) by offering a 5 percent bonus and exemption from MIPS for ECs who participate in an Advanced APM and meet certain participation thresholds. In 2017, ECs must have at least 25 percent of their Medicare payments or 20 percent of their Medicare patient panel in a CMS Advanced APM to receive the bonus and MIPS exemption. ECs who meet lower payment or patient thresholds have the option to be exempt from MIPS. CMS maintains the list of qualifying Advanced APMs here.

Moving Forward

The overarching framework created in the legislation and initial rulemaking completed by the Obama Administration will continue unchanged in 2017. The Trump Administration will have a chance to put its own twist on the QPP in 2017 by filling in the program implementation details through sub-regulatory guidance (much like CMS has done with the Meaningful Use program) and in 2018 and beyond through rulemaking to establish future program requirements. If Representative Tom Price is confirmed as the Secretary of the Department of Health and Human Services, he may accelerate efforts to reduce provider burden and simplify the QPP.

As providers prepare to participate in the first year of QPP and HIOs prepare to support providers’ success, they should keep the following in mind.

• While APMs have gained significant attention in recent years, CMS anticipates that the vast majority of providers will participate in MIPS in the early years of the QPP.
• Providers just beginning to think about the QPP requirements should  generate reports to determine which providers are likely to be an EC during the performance period and which will fall under the low volume exclusion; map out the existing TIN/NPI structure of the organization to help support decision making around group versus individual reporting; and undertake a scan across the organization to determine existing Advanced APM participation by ECs. If an organization participates in an Advanced APM, a report should be generated based on all participating providers to determine if participants will qualify for a bonus and MIPS exemption under the APM track.

HIOs have the opportunity to position themselves to support providers’ success in QPP. HIOs should ensure they have functionality that aligns with program requirements, including:

• Implement certified tools to collect and submit electronic quality measures to CMS to support ECs and help them achieve bonus points for the quality performance category.
• Support ECs success with a variety of ACI measures including HIE (send and receive); view, download and transmit; and submitting information to public health and clinical data registries. A key consideration in determining which measures to support include the existing exchange environment the HIO operates in, if certified technology is required to meet the measure, whether the HIO’s technology meets the requirements (i.e. providing machine readable C-CDAs), and the ability to provide ECs necessary audit documentation.
• Support improvement activities. For example, “Ensure that there is bilateral exchange of necessary patient information to guide patient care that could include one or more of the following: Participate in a Health Information Exchange if available; and/or use structured referral notes.” A key consideration for supporting improvement activities is whether the HIO has the ability to provide ECs with necessary audit documentation.

Kory Mertz is senior manager of Audacious Inquiry of Baltimore, MD.

Morning Headlines 1/18/17

How Repealing Portions of the Affordable Care Act Would Affect Health Insurance Coverage and Premiums

The Congressional Budget Office publishes its predictions on the impact ACA’s repeal will have, concluding that premiums will spike and the number of people who are uninsured would increase by 18 million in the first coverage year following the repeal.

Second Theranos Lab Failed U.S. Inspection

Theranos fails an inspection of its Scottsdale, AZ blood testing lab but fails to disclose this information to its investors.

Introducing IMEDS, a Public-Private Resource for Evidence Generation

The FDA launches the Innovation in Medical Evidence Development and Surveillance System, or IMEDS, which will make the FDA’s Sentinel System data and analytics tools available to private researchers.

The Heroism of Incremental Care

In a New Yorker op-ed, Atul Gawande, MD compares the incremental approach primary care providers take in managing conditions with the one-and-done approaches surgeons prefer, conceding that primary care may be doing more good in the long run.

US insurers get inside cars, mouths, grocery carts in profit search

Reuters covers the use of data mining by health insurers to help price policies and target profitable customers more effectively.

News 1/18/17

Top News

The Congressional Budget Office says that repealing the Affordable Care Act will cause the number of uninsured Americans to jump by 18 million in the first year, swelling their numbers to 32 million in 10 years.

CBO predicts that Insurance premiums for individual policy-holders will increase by 25 percent in the first year following repeal and will double within 10 years.

Reader Comments

From James Jones: “Re: Merge Healthcare. The big story is Nancy Koenig leaving, but the positive news is that the reorg relates to growth, not downsizing, and that the first cognitive product will be releases in Q2 2017. Here’s the internal email sent to the team on January 10.” The internal email says that the first cognitive solution release under IBM Watson Health will address aortic stenosis.

From Pilsner: “Re: Santa Rosa Consulting. Deleted all its past tweets.” I contacted the company, who says they cleaned up their Twitter account following the departure of one of their internal marketing folks. The Twitter account will be put into use again following an upcoming rebranding.

From Willie Slicker: “Re: HIStalkapalooza. You should keep doing them – it’s great for HIStalk branding.” I don’t pay much attention to HIStalk branding, but as it stands, what I am paying attention to is the check I’ll have to write to cover the event’s cost beyond what sponsors are graciously underwriting. That has understandably dampened my enthusiasm from throwing further free parties since I have to ante up nearly double what I paid for my last new car a couple of years ago.

HIStalk Announcements and Requests

Thanks to our two new HIStalkapalooza sponsors. Lucro offers a digital platform that helps health systems make better, faster, less-risky purchasing decisions. Physician’s Computer Company (PCC) provides EHR/PM for pediatricians that consistently out-KLASses all competitors with a 95.1 overall score.

We helped Ms. L from Missouri in funding her DonorsChoose grant request for STEM learning materials. Her fourth graders are building the example electronic circuits and will then move on to creating their own designs.

Listening: new from Kvelertak, face-melting heavy metal from Norway that requires all of my limbs for desk drumming, complete with showy flourishes of my imaginary sticks. Face-melting isn’t for everyone, so there’s this: new from Khalid, a stunningly expressive 18-year-old singer and musical newcomer from El Paso, TX who blends R&B with old-school soul. Mark your calendars for six months from now – Khalid is going to be big.

Webinars

January 18 (Wednesday) 1:00 ET. “Modernizing Quality Improvement Through Clinical Process Measurement.” Sponsored by LogicStream Health. Presenters: Peter Chang, MD, CMIO, Tampa General Hospital; Brita Hansen, MD, CHIO, Hennepin County Medical Center. The presenters will describe how they implemented successful quality governance programs, engaged with their health system stakeholders, and delivered actionable information to clinical leadership and front-line clinicians. Q&A will follow.

January 26 (Thursday) 1:00 ET. “Jump Start Your Care Coordination Program: 6 Strategies for Delivering Efficient, Effective Care.” Sponsored by Healthwise. Presenters: Jim Rogers, RN, RPSGT, director of healthcare solutions, Persistent Systems; Jason Burum, chief client officer, Healthwise. This webinar will explain how to implement a patient-centered care coordination program that will increase quality as well as margins. It will provide real-world examples of how organizations used care coordination to decrease readmission rates, ED visits, and costs.

February 1 (Wednesday) 1:00 ET. “Get your data ready for MACRA: Leveraging technology to achieve PHM goals.” Sponsored by Medicity. Presenters: Brian Ahier, director of standards and government affairs, Medicity; Eric Crawford, project manager, Medicity; Adam Bell, RN, senior clinical consultant, Medicity. Earning performance incentives under MACRA/MIPS requires a rich, complete data asset. Use the 2017 transition year to identify technology tools that can address gaps in care, transform data into actionable information, and support population health goals and prepare your organization for 2018 reporting requirements. 

Acquisitions, Funding, Business, and Stock

Document solutions vendor Auxilio acquires healthcare security solutions vendor CynergisTek for $34 million in cash and shares. CynergisTek generated $15 million in revenue and $5 million in EBITDA in 2016.

Dear Auxilio, you forgot to change your site’s title in WordPress, so it looks really amateurish in Google searches and on the browser tab. Please correct this at your earliest convenience. Yours, Mr. H(TML), who also wonders whether “at your earliest convenience” really means something since it sounds more like something a non-native English speaker would say. At least don’t make “at my earliest convenience” part of your voicemail greeting because what that means is that you’ll call back whenever you feel like it regardless of your caller’s needs.

Forbes profiles the just-launched Forward, a San Francisco primary care practice started by a serial entrepreneur who sold his artificial intelligence company to Google. Forward describes itself as looking more like an Apple Store than a doctor’s office. Members who pay $1,800 per year are tested on an AI-powered body scanner, are given a wearable device that the practice says it will monitor, and are sold branded nutritional supplements. We’ll have to take their word on having doctors with “world-class backgrounds” since the company is too enamored with its architecture and apps to say who’s actually delivering the care it offers (maybe it’s just a bunch of hipster docs sitting at a Genius Bar). The track record of millennial-pandering “startups” like this is pretty abysmal, both in terms of financial viability as well as making much of a difference in population health. I’ll be shocked if it’s still around two years from now.

Formativ Health – formed last week by Northwell Health and Pamplona Capital Management – acquires EHR/PM/RCM vendor Etransmedia. It’s probably not relevant, but Northwell – the former North Shore-LIJ – uses Allscripts, which in 2014 lost a $10 million deceptive business practices case to Etransmedia, who bought a bunch of Allscripts MyWay licenses for resale only to get stuck with them when Allscripts abandoned the product. Etransmedia developed and sells the Connect2Care EHR/PM.

Sales

John Muir Health (CA) chooses Sectra’s cloud-based image archive and universal viewer.

People

CTG hires Hamish Stewart-Smith (Encore Health Resources) as managing director of healthcare sales for North America. He is a United States Air Force Academy graduate who spent 11 years as an officer.

Announcements and Implementations

HIMSS further blurs the barely visible line it draws between providers and vendors in launching a marketing summit in Las Vegas, with Steve Lieber saying, “We specialize in supporting organizations who market tech solutions to HIT customers.” At least he’s honest in admitting that what HIMSS does best (and most profitably) is to help HIMSS vendor members sell stuff to HIMSS provider members. Another aspect of that blatantly commercial offering is the apparently new HIMSS Media Lab (referenced but not mentioned in the announcement), whose primary objective seems to be selling ad space in HIMSS publications and relentlessly targeting the provider audience in being “obsessed with getting under their skin, on their mind, into their hearts” as they “study professionals in their natural habitat.” It’s interesting that HIMSS is launching a conference targeting marketing professionals while simultaneously trying to take away their business. Provider-siders who feel like lab rats being studied as they attempt to avoid predators now understand that they’re in the HIMSS version of “The Twilight Zone,” where the seemingly normal small town is not as it seems. We are all just paying acolytes in the HIMSS Church of the Generated Lead.

McKesson offers a cloud-based option for InterQual Criteria.

Government and Politics

FDA announces IMEDS, which will give patient safety researchers access to privacy-protected drug and medical device safety reports. 

I found the ethics disclosure form of HHS Secretary nominee Tom Price, MD, who reports holding shares in Athenahealth and McKesson. Meanwhile, Sen. Al Franken and two colleagues ask to have Price’s confirmation hearing postponed pending an ethics investigation after reports that he traded shares of healthcare companies while sponsoring legislation that could have affected their share prices to his benefit.

McKesson will pay $150 million to settle federal charges that it violated the Controlled Substances Act by failing to report pharmacy customers that ordered suspiciously large quantities of oxycodone and hydrocodone. The company will also stop filling controlled substances orders from its distribution centers in four states.

Privacy and Security

From DataBreaches.net:

• Sentara Healthcare (VA) notifies 5,000 patients that their information was exposed in a breach involving an unnamed Sentara vendor.
• Little Red Door Cancer Services of East Central Indiana is hit with ransomware, with hacker The Dark Overlord demanding a $43,000 payment that the non-profit agency declined to make since it was able to restore from a cloud-based backup.
• In Canada, a pediatrician who had been accused by several parents of falsely claiming they had abused their children kills himself after sending a media outlet a USB drive with patient information that apparently supports his abuse claims.

Reuters covers the ways insurance companies are using technology to measure customer behavior and potentially to set premium rates accordingly. Examples: a Bluetooth-enabled toothbrush that phones home to a dental insurance company, car monitoring devices that record driving habits, and fitness trackers whose information is reported back to insurers. Those in favor say the information can change behavior positively, while critics are concerned that the information will be used to charge some customers more or to cherry-pick only lower-risk consumers.

Other

A review of the Orphan Drug Act concludes that drug companies have hijacked the law’s noble intentions (encouraging them to develop drugs for rare conditions) by invoking orphan drug status for mass-marketed drugs to get seven more years exclusive marketing rights. The skyrocketing number of orphan drug approvals includes such bestsellers as Crestor, Ability, Herceptin, and the Humira (the world’s best-selling drug) as companies repeatedly file for protection using new rare conditions. Seven of the 10 best-selling drugs were so-called orphan drugs that earned rare disease approval after the fact. Drug companies are being coached on the process by former FDA officials who have hung out consulting shingles for fees that can approach $100,000, suggesting that the companies employ approaches such as trying out their existing drugs for treating unusual diseases in Africa. 

A Johns Hopkins study finds that privately insured patients get stuck with the high bills of out-of-network doctors hired by in-network hospitals, noting that the doctors with the highest markup (defined as the multiple they charge private patients vs. their Medicare rates) are those the patient doesn’t choose. Anesthesiologists, ED doctors, pathologists, and radiologists charge four times the rate Medicare pays them. Anesthesiologists in 10 cities made up the top 2.5 percent.

Surgeon-author Atul Gawande, MD admits in a New Yorker article that he has failed to appreciate the role of the primary care physician whose impact on health is less immediately decisive but no less important than the stroke of his well-aimed scalpel. He notes that his OR is equipped with a battalion of people and millions of dollars worth of equipment, while “incrementalists” are lucky to afford a nurse. Some snips:

We will increasingly be able to use smartphones and wearables to continuously monitor our heart rhythm, breathing, sleep, and activity, registering signs of illness as well as the effectiveness and the side effects of treatments. Engineers have proposed bathtub scanners that could track your internal organs for minute changes over time. We can decode our entire genome for less than the cost of an iPad and, increasingly, tune our care to the exact makeup we were born with. Our healthcare system is not designed for this future—or, indeed, for this present. We built it at a time when such capabilities were virtually nonexistent. When illness was experienced as a random catastrophe, and medical discoveries focused on rescue, insurance for unanticipated, episodic needs was what we needed. Hospitals and heroic interventions got the large investments; incrementalists were scanted …But the more capacity we develop to monitor the body and the brain for signs of future breakdown and to correct course along the way—to deliver “precision medicine,” as the lingo goes—the greater the difference health care can make in people’s lives, as well as in reducing future costs. This potential for incremental medicine to improve and save lives, however, is dramatically at odds with our system’s allocation of rewards.

Sponsor Updates

• HBI Solutions produces a video titled “Spotlight Data Solution Overview.”
• Agfa Healthcare publishes a new white paper, “How Enterprise Imaging Aligns with Value-Based Care.”
• Besler Consulting releases a new podcast, “A closer look at patient reported outcomes.”
• EClinicalWorks will exhibit at the NHMI Annual Orthopaedic Winter Meeting January 20-21 in Stowe, VT.
• Healthgrades announces the recipients of its 2017 Distinguished Hospital Award for Clinical Excellence.

Blog Posts

• How that EHR is Not Working for You? (Optimum Healthcare IT)
• How AdvancedMD is Changing Independent Practices Like Yours (AdvancedMD)
• 2017 Healthcare Trends Part 1: The Rise of Patient as Consumer (Catalyze)
• Seniors Seek Better Care Coordination (CareSync)
• A Eureka Moment – Insights from a Consultant (Culbert Healthcare Solutions)
• Why Physician Succession Planning Can’t Wait (ECG Management Consultants)
• Why Does the Healthcare Industry Need Millennial Physicians? (Evariant)
• Ready, Set, Time to Prepare for HIMSS 2017! (Galen Healthcare Solutions)
• The Devil is in the Details: Why You Need an Efficient Tracking System Now (Hayes Management Consulting)
• MACRA: 3 Vital Questions to Ask Yourself (HCI Group)

Contacts

Mr. H, Lorre, Jennifer, Dr. Jayne, Lt. Dan.
More news: HIStalk Practice, HIStalk Connect.
Get HIStalk updates. Send news or rumors.
Contact us.

Morning Headlines 1/17/17

Trump Is Considering Another Thiel Associate to Lead FDA

President-elect Trump is reportedly considering Silicon Valley executive Balaji Srinivasan to lead the FDA. Srinivasan has no medical background, but earned consideration because he is a Peter Thiel associate.

Survey Snapshot: What Patient Engagement Technology Is Good For

A recent NEJM Catalyst survey on patient engagement tools finds that providers are excited about the potential benefits associated with new technologies, but do not know which ones to recommend.

You can now book workout classes directly from Google

Google partners with digital health startup MindBody to let users search for, book, and pay for exercises and wellness classes from within Google’s search results.

Why Regulating AI Is A Mistake

Following the recent death of a passenger who was driving in an auto-piloted Tesla, AI experts weigh in on the pros and cons of regulating the use of artificial intelligence.

Curbside Consult with Dr. Jayne 1/16/17

In the hospital, a curbside consult is an informal consultation between physicians that avoids the sometimes cumbersome request and documentation requirements for a “real” consultation. Of course, without the request and documentation piece, it also avoids the billing and payment piece, so it’s essentially a freebie given between colleagues.

Most of the time you never know who the patient is. It just starts out along the lines of, “I wanted to pick your brain about this guy…” Doctors get curbsided by their friends and family members as well, usually about a test result or a visit to the doctor. Most of the time the requests I get from friends are easy to answer. This week though, my IT colleague Jimmy the Greek asked me to translate his MRI and I was digging deep to find anything in my memory about a “pistol grip deformity” of the hip.

Thank goodness for eOrthopod, who was able to quickly answer my question so I could talk intelligently about his situation, which I had been following tangentially over the last few months. As we go boldly where no one has gone before with a new president and the impending repeal of the Affordable Care Act, I thought it was worthy of sharing and discussion. So get your popcorn, wine, tequila, or other beverage of choice and sit back for the first installment of Dr. Jayne’s Journal Club, where we will review a patient case presentation.

A year ago, I injured my hip in martial arts class participating in kicking-for-height competition with a 15-year-old whose flexibility would make Gumby green(er) with envy. I’ll have your loyal readers know that I won that contest, despite the fact that I seem to have lost the war, and have now been set adrift in the murky waters of consumer-driven healthcare. For months, my hip would hurt, so I’d rest it, but then go take another martial arts class, where I’d aggravate the injury again. I finally quit taking lessons in August and I assumed that without the thrice-weekly strain I was putting on the injury, it would heal quickly. Finally, in October, I couldn’t take it anymore and went to see my chiropractor. (Being a savvy consumer of healthcare services, I didn’t want to go see my orthopedist right off, as that’s like asking my barber if I need a haircut).

After a few weeks of adjustments, home exercise, and K-Tape, my chiropractor referred me to a physiatrist. I was warned ahead of time that, “He and his office staff are . . . a bit quirky.” My first impression of this highly-regarded doctor was formed when he blasted the exam room door open, pointed at me, motioned toward the hallway, and said “You – come out here.” While his bedside manner (and as I learned later, professionalism) left quite a bit to be desired, he seemed knowledgeable and capable, and really, that’s what’s important.

I was sent for an x-ray to rule out anything skeletal and told that the office would receive the results electronically and call me to discuss next steps. After completing the x-ray, I left a voice mail in the practice’s general mailbox to let them know. The outgoing message admonished me to wait at least 48 hours for a reply and not to call back before then, as doing so would drop me to the end of the line. I waited a whopping four days for a call back and finally decided to risk my place in line. The not-so-cheery voice on the other end of the phone told me that no, I would not get a call, and no, I did not need an appointment. All I had to do was show up on the practice’s doorstep, imagery in hand, and the doctor would see me immediately. I agreed to come in the next week, as I was on vacation from work.

Fast forward to Monday morning, when I darkened the aforementioned doorstep with my presence. Sadly, that’s all I could darken because the door was locked. It seems that this paragon of all that is good and right with the practice of medicine decided to take Monday off. The desk staff was working, however, and when I bent their collective ear about better communication with patients, I was (quite literally) screamed at for my trouble. For those of you keeping track at home, I had already been given two conflicting pieces of information about how to get my test results, neither of which I would later find out was correct. Dr. Professional reviewed my x-ray early the next morning and decided I was in need of an MRI with contrast agent.

This morning, I dutifully arrived 15 minutes early for the procedure so I could fill out the exact same paperwork I had filled out before the x-ray, despite the fact that I was merely at a different location of the same imaging firm run by the same hospital system. I was told by the technician who was getting me prepped for the procedure that the radiologist performing the arthrogram is notoriously late. When she finally arrived (15 minutes after her scheduled start time), she approached me with a needle that looked like a cross between a whaling harpoon and the drill bits that arctic researchers use to take core samples. Once the lidocaine kicked in, though, it didn’t matter. The staff tried valiantly to get me to use the standard MRI machine, but in the immortal words of Clint Eastwood, a man’s gotta know his limitations. Mine happen to include enclosed spaces. Off we went to the “open” machine, which, much to my chagrin, is about as open as Internet access in North Korea. I only required one break from my incarceration in the evil machine.

Instead of going straight home, I decided to drop in on Dr. Wonderful (CD in hand) to get his take on my MRI. While en route, I called the office to make sure he was there. It only took me three tries to get through to a human. When I told her why I was calling, she was astonished that I would ever think to just drop in, because as everyone knows, an appointment is required to review imaging results with the doctor. So now I wait until next week.

I am familiar with the physician in question, but hadn’t had any patients in common for nearly a decade, so decided to do some Google stalking. He’s on staff at Big Medical Center, so would have access to the clinical data repository at a minimum and most likely would have direct access to the PACS due to his specialty. He’s been recognized multiple times by his peers as one of the community’s “Best Doctors in Town” which can be confusing since patients don’t understand how those honors are usually bestowed. Our city’s magazine that runs the feature every year solicits feedback from other physicians, but many of us think it’s a joke because one colleague had moved away three years prior but continued to be on the “best doctors” honor list.

He’s got four stars on Healthgrades with 28 reviews and no disciplinary actions by the board of healing arts. But it sounds like his practice is disorganized and doesn’t take advantage of patient-friendly technology solutions like a patient portal or secure messaging, even though they have a portal link on the practice website. There’s no information on the website about the processes and procedures that didn’t work so well in this case, so a patient looking to do things the “right way” would have trouble confirming.

Of course, in consumer-driven healthcare, the patient’s main recourse is to vote with his feet, which is sometimes challenging to do when you’re partway into a course of treatment or into a diagnostic process with another provider. Fortunately, our patient has his imaging studies in hand, which sadly not every patient has. Our patient is also a well-educated IT guy with the flexibility to make time during the day to call offices and run down results, and many patients don’t have the ability to do those things, making their diagnostic and treatment course even more fragmented.

When I hear about situations like this, I think about whether technology would have made anything better. There were definitely some opportunities here, but the real issue isn’t something that the current focus of regulation or rulemaking is going to address, other than patient satisfaction scores, which I hope were appropriately low in this case, if they were even solicited.

Our patient has since been referred to an orthopedic surgeon, so we’ll have to check in with him down the line to see if the brave new world of high tech healthcare has done any better for him. As a consultant, I see these situations all the time, and typically the physician is resistant to change as are the members of the office team, who seem to be part of the problem here. The worst cases are often the hardest to fix.

Email Dr. Jayne.

Morning Headlines 1/16/17

Justices Will Hear Challenges to Mandatory Employee Arbitration

The Supreme Court agrees to hear a case brought by Epic and two other corporations seeking clarification on the use of arbitration clauses in employment agreements that prohibit employees from banding together to take legal action over workplace issues.

Hospital closes systems after IT attack

In England, Barts Health NHS Trust shuts down several of its IT systems after suffering a “non-ransomware” cyberattack.

The Biggest Changes Obamacare Made, and Those That May Disappear

The New York Times offers point-by-point analysis of the real impact of repealing ACA and outlines possible replacement legislation.

Rudeness and Medical Team Performance

Researchers in Israel finds that when nurses are scolded by rude patients, their performance decreases across all measured clinical quality categories for not only that patient, but all of their patients. Preventative cognitive bias modification programs were shown to help neutralize the impact rudeness has on performance.