EPtalk by Dr. Jayne 11/17/16

I heard from a couple of clients that CMS has started to notify practices of their selection for the Comprehensive Primary Care Plus initiative. Although the web site says that they updated the Region and Payer lists on November 15, I was unable to find the updated lists on the site. I’m assuming they’ll be putting out a press release shortly, but it would be nice to get the information from the source before clients start calling. The program starts January 1 and there is much work to be done for those selected.

Some of my clients who applied don’t have experience with prospective payments and may need retraining on their practice management and accounting systems to ensure they know what do to with the money and how to manage it. Fortunately my partner has a lot of experience in this regard, but it’s a learning opportunity for me as well. In urgent care, the only prospective payments I deal with are our occupational health contracts and that’s a different kind of accounting altogether.

I’m receiving a lot of requests for support from organizations that are relatively new to value-based care. One in particular has received reports from their ACO and the numbers don’t line up with what they are seeing in data from their EHR vendor. Reconciling competing reports isn’t one of my favorite pursuits, but I’m fortunate to work with a great data analyst who is going to start digging in. I’m suspecting that the ACO data might have issues since there are measures that have the same population and one is showing a zero denominator where the others clearly have denominators. One would think the ACO would have reviewed that and completed some data integrity checking before sending their participating practices into a scramble.

I think we’re going to start to see some buyer’s remorse as practices realize what ACO membership really means for them. I’ve seen quite a few independent practices that felt pressured to join organizations or risk being left out of referral networks. Some independent practices don’t have the most business-savvy people making decisions and may gave gotten more than they bargained for with regard to their responsibilities as part of the ACO. In this particular situation, the ACO agreement didn’t address the idea of what happens when there are data reconciliation issues. Even when we complete the analysis, my client might still be penalized based on the faulty data. These types of issues are going to continue to surface as more organizations move into the value-based care space but might not have the expertise to fully manage what they are trying to do.

I spent several hours this week completing mandatory Maintenance of Certification activities for my primary board certification. It was a depressing activity since many of the questions covered minutiae that is hardly germane to the realities of practicing medicine. The format was an online “knowledge assessment” with provided citations for the information behind each question and answer. Notice I said “citations” and not “links” because finding the references was a manual process, and for some, a Google search failed to locate the materials. Other materials were fee-based and many were more than a decade old. I began to distrust whether I was spending my time wisely trying to find the right answer to pass the assessment vs. knowing that I was reviewing current information.

One of the questions were around the 2008 Physical Activity Guidelines for Americans, put out by the US Department of Health and Human Services. I’m not sure I need to know whether the Guideline officially recommends the frequency for alternating various types of activities in order to be a good physician. What I do know is that most of my patients need to eat less and move more. Splitting hairs with them on whether they prefer moderate-intensity exercise at a weekly minimum of X minutes vs. vigorous activity of Y minutes doesn’t play out in the six-minute office visit. If they’re overweight or have diabetes, hypertension, or metabolic syndrome, I need to focus on telling them that if they’re exercising they’re moving in the right direction and that they should consider doing more.

Maintenance of Certification is particularly difficult for those of us that work in non-traditional capacities or limited practice situations. For example, the modules where I am supposed to do practice improvement activities don’t necessarily apply to me because I don’t follow patients in continuity. Rather than giving me opportunities to do something relevant to my work, I have to do the same activities that traditional physicians do but with simulated data, and the learning value is pretty low. It’s particularly low because I’ve already done the exact activity before, in my last recertification cycle, because there are so few options for non-traditional physicians.

We are forced to maintain our primary board certifications for a couple of reasons. First, to be credentialed by payers, you generally have to be certified. Second, even to practice clinical informatics, we have to maintain a primary board certification. It’s a catch-22 for many of us who might consider dropping clinical practice altogether but want to stay certified in clinical informatics.

Speaking of that certification, the American Board of Medical Specialties approved a five-year extension on the so-called “practice pathway” to clinical informatics certification. Physicians who are currently practicing clinical informatics but who have not completed a fellowship can apply for certification through the 2022 examination cycle. I am grateful to AMIA for keeping everyone informed. The announcement cited continued workforce demand and opportunities for physicians seeking a full-time informatics career as contributing factors. Now we need a pathway for those of us who don’t want to maintain a primary certification to go “all in” for clinical informatics.

I’m way behind on my email due to some back-to-back travel and trying to get my board certification activities done. I was interested to see a request by the Food and Drug Administration for submissions on “Emerging Issues and Cross-Cutting Scientific Advances.” The FDA regulation process takes years, creating a need to assess how to regulate advances that are just now being thought of. The blog piece mentions ideas like intraoperative hibernation and brain-computer interfaces as examples. Submissions to the Emerging Sciences Idea Portal will be public, so I’ll have to make a reminder to follow up.

I’m taking a long weekend to recover from the chaos of the last several weeks. It put a dent in my frequent flyer and hotel points, but it’s exciting to have a trip planned that I’m actually looking forward to.

What’s your favorite long weekend getaway? Email me.

Email Dr. Jayne.

Morning Headlines 11/17/16

Sign-Ups Under Affordable Care Act So Far Seem Not Hurt by Donald Trump’s Win

Healthcare.gov has processed over a million applications during the first 12 days of open enrollment, outpacing last year by 53,000.

Trump May Repeal Obamacare But He Won’t Touch Obama’s Other Major Health Law

According to Forbes, MACRA, which was passed with bipartisan support, will not be targeted for repeal or revisions under a Trump presidency.

Trump’s HHS secretary could be surgeon Rep. Tom Price

Trump is reportedly considering Representative Tom Price (R-GA) for HHS Secretary. Price was an early Trump supporter and has been a longstanding critic of the ACA.

Health Technology And Human Touch Need Not Be At Odds

In a Health Affairs blog, Eric Topol MD discusses the needed balance between technology and presence in the exam room.

Readers Write: The Next Phase for Recovery Audits

The Next Phase for Recovery Audits
By Nicole Smith

Healthcare providers have reveled in the abatement of audits by recovery auditor contractors that have been silent during the last two years of legal challenges and the procurement process resulting in a tremendous reduction — and in some instances, a pause — of recovery audits. During this down time, the Centers for Medicare and Medicaid (CMS) has been working tirelessly to procure new audit contracts – which they have now done — while dealing with post-award protests and growing concerns from the provider community about the administrative burden audits impose, as well as the methodology in which the contractors had been auditing.

CMS has said multiple times that it is committed to maintaining the integrity of the Medicare program, but its latest priority has been reducing provider burden. With contracts finally awarded to Cotiviti LLC, Performant Recovery, Inc. and HMS Federal Solutions performing post-payment audit reviews for Medicare Part A and Part B, CMS added a new fifth region that will be dedicated to identifying improper payments for durable medical equipment and home health and hospice providers. The fifth region was awarded to Performant Recovery, Inc.

Providers can expect to see some program enhancements that will improve the provider experience once the new contractors resume auditing. Providers should familiarize themselves with the upcoming changes and revise their workflow to efficiently handle Medicare audits.

While recovery audits can impose a tremendous administrative burden on a provider and can have a negative financial impact on a health organization, developing a plan to manage the audit process may prove to be beneficial for providers. For a process that has been largely paper-based up to this point, CMA implemented changes the past two years to streamline the audit submission process after contractors issued more than 2 million requests annually. Thus, CMS recognized the need to develop an electronic process so that providers and health systems could process their responses to audit contractors electronically without paper.

The Electronic Submission of Medical Documentation (esMD) program was developed as part of strategic plan to transform business operations and uphold their commitment to modernize business processes, streamline medical documentation submissions, and sustain enrollment gains in the Medicare program.

Providers have long since felt that the contingency fee basis in which recovery auditors were reimbursed encouraged auditors to target and deny a high volume of high-dollar claims, resulting in false denials and leaving the burden on the provider to appeal the decision – all while the monies paid were recouped. The appeals process can take years and tremendously impacts organizational revenue. CMS revised the way in which auditors will be reimbursed.

Now, recovery auditors will not receive their contingency fee until after the second level of appeal is completed. Additionally, auditors are required to maintain a 95 percent accuracy rate and an overturn rate of less than 10 percent at the first level of appeal. Failure to comply will result in corrective action for the recovery auditor. This is one of the most notable changes that directly addresses concerns of the provider community.

Further testament to CMS’s apparent commitment to minimize provider burden is the ability for providers to electronically file level one and level two appeals through a CMS Certified Health Information Handler (HIH) for esMD. These new esMD use cases alleviate providers from the overwhelming costs of printing, mailing, and tracking of supporting audit documentation while also helping to ensure timely filing, which historically has contributed to denials for providers as well.

Through the updated RAC contract, CMS also will require recovery auditors to provide detailed information about current recovery audit issues. This information is expected to be posted and reviewable on the auditor website for all the see, creating an added level of transparency for the entire process. Providers can proactively prepare for the identified issues by reviewing Medicare billing rules and making sure they are billing in compliance and have all the necessary support documentation in the event of an audit. If providers remain focused on compliance and timely filing recovery, audits should have little impact on the provider – at least that’s the hope.

In addition to the administrative burden of managing Medicare audits, providers have often felt that they had no direct line of communication with CMS regarding the audit process if they encountered an issue related to an audit. Frustration often grew quickly as providers tried in vain to contact someone at CMS while attempting to address any issues they may have had. From my experience with the program, providers often felt bounced around when trying to locate the appropriate person to speak with. To alleviate this problem, CMS created a new position, a provider relations coordinator, designated as the single point of contact for the provider community. The provider relations coordinator is meant to create a streamlined communication outlet for concerns with the recovery audit program.

With the return of the recovery audits on the horizon, providers should use this time to review their internal processes for handling audits and closely monitor regulatory requirements and changes in compliance policies and procedures to develop best practices for their audit program. The program, based on the developments spoken of here, are meant to ensure a more democratic, effective audit process for every party. It is my belief that the program will be less combative, less of a financially-driven attack on health systems by audit contractors, and more of a process designed to right any accidental billing wrongs and return legitimate overpayments to CMS, an equitable approach for all.

Based on the program updates, health systems will have a voice now and will be able to engage CMS directly, if needed, to mitigate any potential overzealousness the previous iteration of the program seemed to create. Perhaps now the audit process will more resemble the image of a negotiating table rather than one where an aggressive takeover seems to be occurring, as was an often-expressed sentiment of those working in the care space.

While program changes may continue, and with all signs indicating that the recovery audit program is here to stay, having a solid plan with proven best practices will minimize the administrative burden. Nevertheless, the news from Washington is good and likely portrays better things to come.

Nicole Smith is VP of operations and government services for Vyne of Dunwoody, GA.

HIStalk Interviews Robert Lord, CEO, Protenus

Robert Lord is co-founder and CEO of Protenus of Baltimore, MD.

Tell me about yourself and the company.

My co-founder Nick Culberston and I started Protenus when we were both in medical school. We started in response to a big problem that we saw in healthcare, which was that with the rollout of electronic health records, there has not been an effective attendant rollout of privacy and security measures to protect that data, particularly from an insider threat prospective.

Nick and I had backgrounds before healthcare as well. He was a Special Forces operator for the US Army. I was a quant at a hedge fund. We had seen a very different way of tackling the problem of insider threats, protecting VIPs, co-workers, all of those individuals from abuse of their PHI. We built a platform that could shift the paradigm of how we protect patient privacy.

What insider threats are you seeing and how prevalent are those compared to high-profile cyberhacking incidents such as ransomware and phishing?

From our own tracking and independent research, we see that a pretty consistent 40 percent of incidents are linked to the insider threat versus the external hack. While we think that there’s a lot of good work that’s been done on the external side — you see a lot of development in the space — there’s a lot less thoughtful work that’s been done when it comes to insiders, particularly in a healthcare-focused way. That’s been a big challenge.

Healthcare has a huge number of idiosyncrasies and challenges that are unique to the industry. It requires a deep understanding of the workflows and special challenges that the healthcare providers have, like the need for open access to records, the fact that individuals can have irregular workflows and patterns of activity, and the fact that there are huge amounts of data streaming through all of these systems and often in ways that are difficult to understand how they relate. It  takes a different approach, one that can integrate big data techniques and machine learning to get a better handle on this challenge.

Is there a higher likelihood of reputation-damaging behavior from insiders rather than outsiders since the person responsible was given explicit trust as an employee, doctor, or business associate?

Charlie Ornstein of ProPublica did an interesting piece on this. The individual, one-on-one breaches do the most damage because they are more personal, more focused, and more likely to lead to liability and bad blood between the hospital and the affected party.

A big hack from an external actor — whether it’s a foreign government or an individual — or an exposure of a database online can affect a huge number of patients. However, the most acrimonious and reputation-damaging incidents are these insider threats. It’s not just a theoretical exposure, but someone intentionally doing something with patient information, and patients react differently to that. When it’s that close to home, it hurts in a different way.

We know in healthcare that these systems are terrifyingly insecure and vulnerable because of the generally open access architecture, but a lot of patients don’t really appreciate that fact. They’re flabbergasted when they see this type of insider threat from someone in the circle of trust for that hospital.

That’s the big challenge. All of this is a question of trust. If patients start to lose that trust, if we have a crisis of that trust, then what are the implications for the larger system? Hospitals understand that at some level, but we don’t always see the attendant investments and awareness, sometimes at the C-suite level. There’s a lot of reasons for that, but it’s an interesting question that we’re going to have to tackle, both at the individual institution level as well as at the federal government level as they think through mandates of how to improve these systems.

What are some examples of issues your system has detected?

Obviously to protect our clients we can’t go too much into specifics, but the types of things that you see typically in this space include the classic co-worker breach, where individuals look at each other’s records inappropriately. It can be the VIP breach, where you’ve got a big movie star coming into your hospital and suddenly it seems like everyone wants to go check out their face sheet. 

Unfortunately, we’re also seeing the rise of criminal actors and criminal networks acting inside electronic health records, whether that’s directly having someone in there who is stealing records and diverting them to the black market or if it’s bribing individuals to divert those records to the black market. That has happened for as a little as $150 per record.

Obviously these are some pretty scary vulnerabilities. We’re seeing more and more of it. Then there’s the whole question of what happens to the records afterwards. They can be used for a terrifying array of threats, whether that’s identity theft, medication fraud, Medicare and Medicaid fraud, medical blackmail, or traditional identity theft types of operations.

Does every industry have the same insider threat problem or is it caused specifically in healthcare by insufficiently granular access?

Healthcare unfortunately suffers from a bit of a double whammy. On one side, the information within healthcare is some of the most valuable information that you have. I’m a member of the Institute for Critical Infrastructure Technology and we just released a report on the incredible value of electronic health records on the Dark Web. While there’s a lot of variability, the bottom line is that there are incentives because these are very valuable records.

On the other side, hospitals are pulled in a lot of directions. Those directions don’t necessarily include privacy and security when it comes time to budget. You got so many competing demands for rolling out new electronic health records and associated systems, different informatics  programs, obviously you’ve got the Meaningful Use incentive programs and MACRA. What you’re seeing is hospitals saying, I’ve got to do all of these different things and I’m not really sure where to put privacy and security on the roadmap, But simultaneously, if you don’t put those on the roadmap, in the long run you’re going to degrade the trust that allows those other programs to be successful.

Hospitals are caught in a tough situation right now. Health systems in general are trying to navigate those waters as effectively as they can, but it’s quite difficult. That’s what is leading to these breaches, in addition to those open architectures, the ease at which people can access this data, and the historical lack of technologies in this field to detect and thwart these types of threats.

What kind of normal user behavior does the system learn in being able to identify exceptions?

We take information from the EHR record and from the patient record, then weave it together with access logs, metadata, and a lot of other information that allows us to understand the second-by-second pattern of every single user in the electronic health record. By doing this, we can detect threats that go outside the traditional rule-based paradigms.

It’s never just one thing. It’s usually an entire constellation of things. The types of patients they’re treating, the types of actions they’re taking, the manner in which they’re moving through the medical record, and the amount of time they’re spending in it. Everything from the very simple to the extraordinarily complex.

With a big data platform that uses some of the best in machine learning and artificial intelligence and a lot of the advances that have come out there recently, we’ve built this ensemble anomaly detection system that incorporates a lot of different perspectives. Not just a single type of scenario, but a lot of different ones. We’re able to find everything from the simple types of threats, such as co-workers or family members looking at each other, all the way to extremely complex threats that we wouldn’t really have a name for, but as soon as you see it, you realize this is extraordinarily bad. The type of actor who might during the day have appropriate access to a certain department, but in the evening, on a particular workstation, or when looking up a particular subset of patients, their actions are inappropriate. It’s a subtle difference that won’t be caught by more basic analytics.

What kind of integration is required to put together the package of information that allows you to make that detection?

Our team has a lot of experience in the big data space, data integration, and doing this type of at-scale analysis. We’re investing heavily in our ability to do data integration easily. What we ended up building was a platform that could ingest data from any number of sources and be source agnostic, both in the number of sources as well as type of source. We then can push everything up to a more universal data schema and analyze from that layer. That way we avoid a lot of the laborious integration that often happens with other systems. There have been a lot of advances in technology that have allowed us to look at the data more from a first principle standpoint and then figure out exactly the elements that we need on a dynamic basis, instead of a highly manual and specified basis.

Do you have any final thoughts?

Healthcare is fundamentally facing a crisis in trust in our systems. We’re increasing the amount of data we collect. We’re increasing the analytics that we’re performing. We’re increasing interoperability. We need all these things to deliver the promise of better care, better patient satisfaction, and decreased cost. In no way do we want to stand in the way of all of this great data-sharing.

Simultaneously, if we can’t build that trust in the system, if we can’t establish a new paradigm for how we’re going to protect all this data and make sure people are accessing data appropriately, then we’re going to lose all of these benefits in the long run. 

As both privacy and security wonks as well as data scientists, we’re really excited here at Protenus about being able to push forward those advances in data science when it comes to privacy and security, just as they’re being pushed forward in improving patient care. I think that’s a big trend that we’re seeing and something we’re very hopeful about. 

While we think that in the immediate future things are probably going to get a little bit worse, in the long run, we’re going to have a much better system. Maybe even better than those in other industries, because healthcare is going to be tackling the hard problems first.

Morning Headlines 11/16/16

Report on the Safe Use Of Pick Lists In Ambulatory Care Settings

Citing a high frequency of pick list-related errors, ONC publishes a report on the safe use of medication and patient pick lists in ambulatory EHR with recommendations for vendors, CMIOs, and end users on how to minimize risks.

CareCloud Completes $31.5 Million Series C Funding Round to Further Modernize Healthcare

Ambulatory EHR vendor CareCloud raises an oversubscribed $31.5 million Series C, bringing its total funding to $103 million.

The American Heart Association and Amazon Web Services Launch Cloud-Based Precision Medicine Data Marketplace to Accelerate Scientific Discovery

The American Heart Association announces that it will begin storing data sets from drug companies, research institutes, and universities in the cloud for researchers to analyze in hopes of advancing cardiovascular disease research.

White House Official Warned VA About New Vets.gov Enrollment App; Records Crisis Continues

The VA goes live with a new online healthcare application without getting approval from the agencies lawyers because of legal and technical issues that ultimately led to 65 percent of applications being lost.

News 11/16/16

Top News

ONC issues a report on improving the usability of pick lists for choosing patients and medications in an ambulatory care setting that also includes an EHR self-assessment. It recommends that vendors and/or users:

1. Include a patient photo in their record to make sure the right patient was chosen.
2. Standardize drug names using the concept of an e-prescribing preferred drug description name.
3. Use pick list best practices, including display standards and proper validation and decision support checks.
4. Display a summary screen before accepting a pick list-chosen medication order.
5. Provide simple retract-and-reorder functionality and monitor its use to identify design problems.
6. Give patients their own medication lists as a second check.

Perhaps ONC should have edited the report more carefully since “prednisone” is repeatedly listed as “rednisone” in the section advocating standardized drug names. The example drop-down also misspells the trade name “Lamictal” as “Lamicatal” and the generic name “lamivudine” as “lammudine.” Even “aspirin” is misspelled as “asprin” in the sample visit summary.

Reader Comments

From FLPoggio: “Re: consultants. People who need them don’t know how to use them. People who know how to use them probably don’t need them.” That’s probably true – the organizations that hire consultants are often clueless, overworked doing the wrong things, and obsessed with protecting their fiefdoms. The last thing they want is change, which is why I would advocate that the person who hires the consultant be one notch higher than the people who will be most affected by their recommendations. IT strategy consulting should be engaged by whoever the CIO reports to, for example, and that’s the person who should make sure the recommendations happen.

From Killian Red: “Re: AMIA. I see a lot of suits in those tweeted photos!” I can never figure out why people wear suits to conferences, ensuring that they will be less comfortable, indistinguishable lemmings compared to that one enviably free-spirited guy who struts through the exhibit hall wearing shorts, tennis shoes, and a backpack, ignoring the raised sartorial bar and instead limboing happily under it in avoiding the corporate battle uniform. There’s not even anyone there to impress except peers from elsewhere. Some of the dimmest, most self-absorbed, and most dishonest hospital IT people I’ve known wore suits everywhere at work (even walking to the restroom or going out to lunch), which might validate the theory that anyone can get promoted by projecting a fabric-driven aura of marginal competence paired with excessive sycophantism and unchecked ambition. Like most of life, the best person doesn’t always win – often it’s the one who wants it more.

HIStalk Announcements and Requests

The industry is about to lapse into its usual Thanksgiving-to-New-Year’s coma, so before that happens and then we all get overwhelmed after January 1, I’ll make a final pitch to companies interested in sponsoring HIStalkapalooza. We still have prime spots left that will ensure the endless gratitude of attendees who will enjoy a fun evening thanks to your largesse, sort of like sending underprivileged hospital IT people to summer camp. I even agreed to hang out privately for a few minutes with the CEO of one sponsoring company who wants that for some dubious reason, so clearly it’s time to deal so I don’t have nightmares about writing that big check personally. Contact Lorre.

Webinars

None scheduled soon. Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Medical practice EHR/PM vendor CareCloud completes a $31.5 million Series C funding round, increasing its total to $103 million.

Non-ICU monitoring system vendor Stasis Labs, which provides a simple bedside display of six core vital signs and a tablet-based app for clinicians with red or yellow indicators, raises $5 million in a seed funding round. Its hardware is manufactured in India, while its software was designed in conjunction with Cedars-Sinai Medical Center.

Sales

UAB Medicine (AL) chooses KyruusOne and ProviderMatch for Access Centers to match patients with available providers to reduce long appointment wait times even while provider capacity is available.

Bayada Home Health Care will identify seniors in need of intervention using technology from Chicago-based PreparedHealth, which offers the enTouch healthcare social network and DINA digital nursing assistant.

Florida Health Care Coalition will offer its members quality and utilization performance reports from Quantros.

Announcements and Implementations

A new Peer60 report covering ideal imaging configuration finds that 72 percent of respondents have pursued an enterprise imaging approach in which the same company provides PACS, VNA, and viewer, mostly because they believe it offers better customer support. Sectra had the highest net promoter score among the enterprise imaging vendors. Just over one-fourth of enterprise imaging customers say they are considering switching vendors, with McKesson leading their mindshare. Among that minority of best-of-breed participants, nearly half would prefer an enterprise imaging approach instead, mostly to facilitate better integration, but nearly all of them say they get better functionality by choosing individual vendors and only 23 percent are actively pursuing replacing their systems with those from enterprise imaging vendors.

Cerner will integrate American Well’s telehealth solution with its HealtheLife patient portal. Amwell offers a $49 urgent care video visit with its own participating doctors, which appeals mostly to health plans and employers, but also offers health systems and practices the ability to launch their own telehealth practice.

Lexmark Healthcare launches a legacy data archive solution, expands its PACSgear suite to allow EHRs to capture and present DICOM content directly from devices, and releases a new version of its enterprise viewer.

The American Heart Association launches a precision medicine platform using Amazon Web Services that will allow clinicians and researchers to analyze data sets contributed by drug companies, research institutes, and universities.

University of Utah partners with South Korea-based Chung-Ang University to create new digital health innovations, including telehealth, that will be applied at CAU Hospital.

Government and Politics

A Health Affairs blog post says CMS’s hospital star rating system is “confusing at best and misleading at worst,” as some hospitals don’t have enough data for some quality categories and CMS reweights the remaining categories accordingly, often to their advantage.

CMS updates its Medicare drug spending dashboard and adds Medicaid spending as well. Four Medicare-covered drugs jumped more than 200 percent in a single year, with the price of blood sugar drug Glumetza increasing from $8 to $39. Medicaid saw a 1,264 percent hike in the price of anxiety drug Ativan, while taxpayers paid $9 billion for the hepatitis C drug Harvoni. Nine of the 20 drugs that had the biggest Medicaid price jumps are generics. 

The VA goes live with a new health enrollment web page without first clearing it with the agency’s lawyers, without training its enrollment specialists on its use, and with technical problems that locked or lost up to 65 percent of the applications filed. It is also not interoperable with the VA’s VistA. The VA turned the application back off and is routing applications manually. Whistleblowers claim the VA intentionally told veteran applicants that they were ineligible for VA care just to reduce the VA’s embarrassing backlog of pending applications.

Privacy and Security

From DataBreaches.net:

• A woman sues Charleston Area Medical Center for providing the medical information of her child to a pregnant acquaintance who the hospital misidentified as her.
• In Canada, Manitoba Health launches an investigation after discovering that a former employee looked up the names, birth dates, and address of patients so she could send them birthday cards.
• A Texas medical practice notifies several hundred patients that their records that were being stored for shedding were accidentally placed in the trash by its cleaning service.

Innovation and Research

The CDC awards a $930,000 grant to University of Missouri-Kansas City, Truman Medical Centers, and Children’s Mercy to compare the de-identified information of 47 million patients stored in Cerner HealthFacts with TMC’s own information to identify laboratory-related quality gaps.

Other

Major League Baseball will standardize the player medical information that teams exchange during trade talks following the 30-game suspension of  San Diego Padres General Manager A. J. Preller, who traded players with known medical issues that he hid from the receiving team by maintaining two sets of their electronic medical records.

Pediatrician Mona Hanna-Attisha, MD, MPH — who discovered Flint, Michigan’s lead poisoning crisis by mining patient data in Hurley Medical Center’s Epic system — will speak at TEDMED, November 30-December 2, 2016 in Palm Springs, CA. Several other healthcare-focused presenters are on the agenda.

Both sides in a New York Times pro-con discussion of mergers agree that hospital consolidation creates consumer-harming monopolies, citing successful FTC challenges presenting evidence that merged hospital competitors raise prices and lower quality.

Lake Health (OH) blames its $30 million loss on an IT conversion that cost more than expected. I assume it was Cerner Millennium since the health system announced that decision in May 2016, replacing the former Siemens Soarian.

The American Heart Association gives its people’s choice technology award to Twiage, which offers hospitals real-time triage and care coordination with incoming ambulances.

Sponsor Updates

• AirWatch VP Blake Brannon looks back at the company’s top innovations of 2016.
• Aprima will exhibit at the American College of Rheumatology conference November
• Catalyze President and Co-founder Mohan Balachandran speaks on the IBM Cloud Innovation Tour November 15 in San Francisco.
• Pater Back, CIO of Meditech customer Humber River Hospital in Toronto, Ontario, is named ITAC’s Canadian CIO of the Year in the public sector category for his work in creating North America’s first fully digital hospital.
• Besler Consulting releases a new podcast, “What will happen to the S-10?”
• Aprima offers a cloud-based faxing solution for its EHR.
• CoverMyMeds will exhibit at Ohio State University’s Wexner Medical Center’s annual Advanced Practice Conference November 18 in Columbus.
• Crossings Healthcare Solutions exhibits at the Cerner Healthcare Conference through November 17 in Kansas City, MO.
• Consulting Magazine includes Cumberland Consulting Group on its 2016 list of fastest growing firms.
• Sutherland Healthcare Solutions publishes a white papers, “Turning Data Into Information and  Moving Beyond Data for Data’s Sake,” and a case study titled “Helping Touchette Regional Hospital Enhance the Patient Experience and Increase Reimbursement.”

Blog Posts

• Integrating Behavioral Health Quality Measures (Arcadia Healthcare Solutions)
• The Truth About HITRUST – and Why It Should Become the Industry Standard (Catalyze)
• Optimization with Provider and Patient Experience (Culbert Healthcare Solutions)
• Realizing Clinical Benefits Part 4 – Race for the Finish Line…and Keep Going (Impact Advisors)

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 11/15/16

Keynote Speaker: John Boehner

HIMSS announces former Speaker of the House John Boehner will keynote HIMSS17.

Cerner and American Well to Embed Telehealth Capabilities into Cerner EHR

Cerner will integrate telehealth services from American Well into its software, allowing providers working within the Millennium EHR to connect with patients over Cerner’s patient portal.

Obama administration disperses last of grants to fund health information exchanges

ONC issues a total of $2.4 million in grants to four state HIEs: Delaware Health Information network, Oregon Health Authority, Rhode Island Quality Institute, and the Utah Health Information Network.

MLB to standardize medical information in wake of A.J. Preller suspension

In the wake of Padres GM A.J. Preller being suspended for hiding medical information during trade talks, the MLB has agreed to a new standardized approach to medical data sharing.

Curbside Consult with Dr. Jayne 11/14/16

Since I’m working both as a consultant and as an employed physician/CMIO, I have the opportunity to interact with quite a few different hospitals, health systems, physician organizations, and vendors. Maybe it’s the Supermoon effect, but it feels like some of the organizations and teams I’ve been working with have lost their rudder. It’s resulting in unpredictable situations that create challenges all the way around.

With one organization, I feel like I’ve been immersed in a spy novel. They’ve been planning to switch EHR vendors for quite some time and are well down the contract negotiation pathway with another vendor. Still, they keep stringing the legacy vendor along, demanding that executives be flown to the client site to address the issues and the relationship so that they can demand discounts and credits for perceived software inadequacies. I say perceived, because I’ve been working with them for well over a year and know firsthand that they haven’t implemented the legacy system correctly and refuse to take my advice or the advice of the other two consulting firms they have on site.

I wish there was some kind of whistleblower hotline to let the legacy vendor know they’re being played, as well as to warn the incoming vendor of the kind of people they’re dealing with. Maybe there is already some level of understanding of the situation, but in working with the earnest and dedicated sales and client management teams, the individual folks working hard to save the client don’t seem to have been clued in and are taking it personally when they figure out the client is lying to them. Client leadership is open about how much they can get out of the legacy vendor on their way out the door and it’s sickening. I’m grateful my contract with them expires at the end of the year because I won’t be offering them a renewal.

Another organization recently engaged me to do some coding education with its providers. In the decreasing world of fee-for-service, they’re eager to get every last dollar out of their problem-oriented encounters. The first thing I did was to look at the coding distribution across their providers, which was fairly close to what I expected. There were two physicians who were significant outliers, but the rest fell nicely along a curve that didn’t vary much by patient mix or payer mix. I figured my task was to first work with the high-end outliers, to find out whether they were over coding and putting the organization at risk. When groups get caught in that situation, the penalty is calculated by extrapolating the overage as if all visits had been handled that way. It’s to an organization’s benefit to rein that in so they don’t have a huge penalty in an audit.

In fact, the group wanted me to address those they perceived as under coding and get them up to the level of their outlier peers. I’m sorry, but if you’re a walk-in primary care clinic that isn’t even addressing complex chronic conditions or significant comorbidities, it’s hard to get a viral upper respiratory infection up to a 99214 E&M code without at least documenting the chronic conditions and how the infection might impact them. Just because you add a prescription medication to the plan or perform a 40-point physical examination doesn’t mean it was medically necessary or that the higher level of coding was justified. I was happy to provide the nuts and bolts coding education. but if they want to encourage up-billing. they’re going to have to use their own physician executives to explain how they want that done.

Another group who engaged me to do a workforce evaluation is being crippled by ineffective management and poor human resources policies. Workers routinely fudge their time cards to make sure they reach 40 hours a week, even though they’re exempt employees who aren’t necessarily required to document 40 hours a week. Unfortunately, they’re damaging their team’s reputation and creating risk for their company. Some of the workers are adding the time to administrative buckets, which negatively impacts the team’s productivity. The worst offenders are padding time on client-facing projects, in effect stealing from their clients six minutes at a time as they increment the billings almost imperceptibly to make up for their own shortages. I recommended that the 40 hours requirement be removed and time be monitored over the next few months to see if there are weeks that people are working more and weeks that people are working less, and to see if they were averaging 40 hours a week as expected. HR cited company policy for the 40 hours requirement, and failed to address the outright dishonesty by their client-facing employees.

I was raised in a world where people should be prepared to face the consequences of their actions, but in these situations, it’s clear that there have been no consequences to date and that those involved don’t even worry about the potential consequences. My business career has been under leadership that expected people to deliver what they said they would deliver, but to do it ethically and in a way that keeps the client at the front of their thoughts and actions. I’ve worked for leaders that were tough but fair, and were honest about the decisions they were making and the potential impact on downstream employees and clients. It’s what I’ve tried to be in my work, but sometimes I feel like the idea of “greed is good” has come back into vogue.

I don’t want to think that so many organizations are spiraling into the muck, and just as I was starting to feel that way, I had a company impress me with its integrity. I helped them with an extremely sensitive project and they made sure that as it unfolded I was in no way compromising my principles or proceeding in a way that didn’t make me comfortable or interfered with my other clients or responsibilities. They didn’t assume that just because I was a consultant and being paid a good amount of money that I was on board for anything they requested. I’ve never worked with a group that was quite that deliberate in how they handled their business relationships, but it was certainly refreshing. It was the kind of engagement that makes a consultant hope that if they eventually want a full-time resource, they’ll keep you on their short list.

I like working with people who say what they mean, mean what they say, and do what they say they are going to do. Are you fortunate enough to have that in your workplace culture? Email me.

Email Dr. Jayne.

HIStalk Interviews Bill Corsten, President, Agfa HealthCare

Bill Corsten is president, North America of Agfa HealthCare.

Tell me about yourself and the company.

I’ve been at Agfa HealthCare since September of 2014, but I’ve been in healthcare IT for just over 20 years, about half of that at McKesson Corporation. I grew up in sales and sales leadership and I still love it, quite honestly, but right now I find myself more motivated by the operational and cultural challenges of running a business like Agfa HealthCare.

This is an old company. We’ve been in business for 150 years and in healthcare since the 1940s. That’s a long and meaningful history because of a commitment to innovation. If you look at the evolution of the company, we’ve been able to maintain a market-leading position in our two primary businesses of medical imaging IT and x-ray technologies.

How is imaging changing with the push for value-based care and care coordination?

When people think imaging, I suppose they think traditional radiology and cardiology, the birthplace of medical imaging. Our more successful customers are taking advantage of the power of medical imaging throughout the hospital and beyond the four walls of that hospital. We’ve got customers who are using it, distributing it, or viewing in upwards of 35 and 40 different departments, so it has gone beyond radiology and cardiology.

Medical imaging in that expanded use can have a tremendous impact on patient care. No medical record is complete without clinical data, medical imaging data, and of course content document management data. There’s still a lot of paper in hospitals these days. We believe we’re completing the medical record and making it better for patients who are our ultimate customers or consumers of healthcare, making it easier for our hospital customers to deliver care more efficiently and effectively for our consumers.

Imaging contains the image itself as well as any clinical commentary or analysis that has been added. What’s the best value case for each of those?

It’s evolving. It’s getting there, but we’ve still got a way to go. If you look over the last decade at the importance of the electronic medical record and the Affordable Care Act’s impact on adoption, it did leave a gap in completing that story. It is really over the last couple of years that we’re seeing the adoption of enterprise imaging and the expansion and the use of that.

If you’re a patient, if you’re a care provider, if you’re a referring physician, to have that picture go along with the words is really completing the story of the patient. It’s not until you have that full story we believe can you make a comprehensive diagnosis and care plan for that patient.

Does imaging have a population health or research component?

Absolutely. Is Agfa HealthCare a population health management primary company? No. Do we participate in that space and are we going to be a key component to an overall solution? Absolutely.

With respect to medical images themselves and the use or data mining of those images, there are use cases where we can look at historic studies. For example, lung nodules, if we’ve got a patient that presents with a lung nodule, a physician may look at that and make a determination — based on the size, based on how long that nodule’s been present — to either act or not to act. To incur that expense and that patient experience or not.

If we can roll forward and have that volume of data or those studies and put together trends, we could use this predictively to make sure we’re making proactive recommendations or not based on like studies that have been stored over time at a particular institution or across the industry itself.

Patients still complain that new providers don’t have access to their previously taken images. Are we making progress on sharing them?

That is the power of our platform. On a single platform, it’s consolidating all of the image data from multiple service lines. It could be from multiple PACS, multiple departments inside the hospital, and outside in a secure manner, which gives access to patients. Lets them see their medical images. It could be providers who are giving the care and it could be the referring physician. Anytime, anywhere. It is absolutely enabling and perpetuating that medical image regardless of proprietary specifics.

How would I as an office-based physician best gain access to a health system’s images of my patient?

Historically you would have CDs. A patient would leave a hospital with a CD, or going way back to the film days, a big manila envelope. What happens to those CDs? They get misplaced or a patient forgets to bring the CD to the referring physician’s office. Then you either lose the time with that physician or that patient doesn’t get the care that they need at the time, it could result in reprinting or populating of that CD.

With the technology that Agfa brings, there is exchange and distribution of that image from the single platform where it was captured. Then there’s viewing capabilities by anybody who participates in that image chain or in that image experience. If I’m a patient or if I’m a referring physician, through the technologies — over and above the original capture of that image — they’re able to distribute and or view that image, taking advantage of eliminating the need for film or CDs.

What is the state and the future state of integrating images with EHRs?

There’s a reason that the big EHR vendors don’t necessarily label themselves as experts in medical imaging. It’s difficult, it’s complex, it’s vast, and it’s a critical component of the legal medical record.

To put our industry in a position where we can take advantage of a single EHR integration across departments, regardless of where they exist, and to connect that to the patient’s medical records so as to bring it all together, it’s only going to make it a better experience, more efficient, more economical. There’s going to be lower total cost of ownership with respect to the number of disparate systems that you’re having to maintain. It will facilitate the flow in the way the physician wants to experience it or the way the patient wants to experience it. That is what is driving our development efforts and our integration efforts when it comes to playing with some of the larger EHR vendors in North America.

What are people doing with VNAs beyond just storing DICOM images?

I come from the EMR industry with 10 years at McKesson. The parallel between then, the clinical data repository and the Web portal or physician portal viewer, and today’s VNA and the viewer … much of our competition had gotten a head start on that and we let them run. We gave them that head start because we took a more holistic approach to this. We wanted to deliver a full solution that was not simply about a repository and a viewer, but it was about the capture and the distribution of those DICOM images to all caregivers, patients, and referring physicians across all settings of care. We took a little different approach to it.

There is non-DICOM imaging. It is a major component. Agfa Healthcare has a very successfully deployed an enterprise content management system in our European customer base that we are now considering bringing to North America. Not for the benefit of competing nose-to-nose with those existing vendors in that space, but actually taking the enterprise imaging and document management and bringing them together so that one and one becomes three for our customers. We’re able to bring that workflow. We’re able to bring the advantages of having non-DICOM and DICOM images managed by the same vendor and distributed into the workflow of our care providers and other caregivers in a seamless and efficient way. That is something that we’re investigating quite seriously.

It’s been said that no doctor wants a physician portal. Is it a challenge to go beyond pull-type systems to pushing the new information automatically to the systems in which the provider works all day?

It can be. You’re right — patient and physician portals have been in the industry for 15 to 20 years. Agfa’s approach to this functionality is different, where we are utilizing it in a use case scenario or problem-solving opportunities as it relates to our enterprise imaging application. We’ve got a portal solution that we are marketing to make it easier for our patients to experience the care provided by their community hospital or their integrated delivery network. We are doing it on a problem-solving approach.

Rather than say we’ve got a physician portal or a patient portal that is to replace the legacy systems that are out there, we are integrating it deeply into our solution so it becomes a seamless component to that experience, whether you’re a care provider or a patient. You’re right — pushing that information is more important than pulling that information. We’re making sure that, much like we have in the development of our core solutions, the information is where they need it and it’s in the hands of the right person on that image chain at the right time.

Where do you see the future of imaging as it relates to medical informatics?

The opportunity is only going to get bigger. The opportunity is for those vendors who are in this for the right reasons, with the right vision, and not trying to isolate themselves but rather to avail themselves to the greater good, which our ultimate patient, the ultimate consumer. Those that recognize interoperability is a must and that we are not going to be all things for all people.

But I absolutely firmly believe that medical imaging, enterprise imaging in the manner that we’re espousing, is going to be a critical component in our delivery of healthcare, whether you look at the development of population health solutions and the participation in HIEs or if you look at a small community hospital. They are the HIE, if you think about it. In their community, they’re everything to their patients.

It’s how we choose to work with our customers to align to their outcomes. That’s going to make the difference and those are the vendors that are going to survive, those vendors that are driving the patient outcomes, driving our customers’ outcomes, and letting those outcomes drive our R&D. That will drive our direction as we look to develop our place in the marketplace.

Morning Headlines 11/14/16

Social Security and Veterans Affairs Partnership Means Faster Disability Decisions for Veterans

The Social Security Administration integrates its disability claims processing system with the VA, speeding up the claims approval process by granting SSA immediate access to medical documents.

Donald Trump, in Exclusive Interview, Tells WSJ He Is Willing to Keep Parts of Obama Health Law

During a Wall Street Journal interview, Donald Trump says that he will preserve some components of the ACA, such as the pre-existing condition exemption and the ability to keep children on a parents insurance plan until the age of 26.

Cerner uses employees’ DNA in pilot research; aims to use genetic info to improve health

Cerner is analyzing full DNA sequences donated  by 82 employees to help the company study how genetics impacts obesity, metabolic syndrome, osteoporosis, and depression.

Monday Morning Update 11/14/16

Top News

The Social Security Administration connects to the VA’s IT systems via the eHealthExchange, allowing it to retrieve the VA’s medical records of veterans applying for Social Security disability. It went live nationally on Friday, Veterans Day.

Reader Comments

From Nasty Parts: “Re: NextGen. Rumor here at UGM is that IKS Health is a potential suitor. Former NextGen and Quality Systems President Pat Cline sits on their advisory board and is CEO of Lightbeam Health Solutions. Maybe they are bringing the band back together – IKS, NextGen, and Lightbeam.” Unverified. UPDATE: Pat Cline’s passed along this comment: ““I am proud to be a member of the IKS Advisory Board but I am fully committed to and focused on Lightbeam Health Solutions and the continued growth of our company and the population health solutions we deliver to healthcare providers. While I believe that QSI/NextGen is a fine company, I am not involved in any acquisition discussions nor am I trying to open any such discussion. I’m squarely focused on the growth and success of Lightbeam so that we continue to deliver the value that our customers, investors, partners and employees expect.”

HIStalk Announcements and Requests

Most poll respondents think the medical practice of their most recent doctor is pretty well run. I asked for details and received these:

• Health IT Chic Extraordinaire says her Epic-using doctor at Palo Alto Medical Foundation and the Cerner-using hospital he sent her (it’s one of five hospitals in which he practices) had mismatched records due to lack of interoperability. She had to fill out the same medical history and medication questions at both, but the hospital’s discharge instructions missed a drug he prescribed immediately before on Epic. She also notes that on the day of surgery, all the information of her tests and other information had been repackaged into a three-ring binder, leading her to ponder if we’ve really come as far as we think.
• Betsy says her OB-GYN was clearly not interested in using practice’s EHR, and during her first visit, his tablet batteries ran out and he called in a MA to take sparse notes. She also observes that she always waited at least an hour (even if she was the second appointment of the day), the practice forgot prescriptions, and their phone tree was dysfunctional. They also collect all payments upfront but failed to return any excess after insurance paid.
• Susan is a big fan of her PCP’s office, which communicates well internally and externally and offers prompt appointments and walk-in sick hours.
• PatientX entered questions before the visit on the practice’s portal that the doctor brought up on his own, making the visit feel more like an ongoing health conversation rather than just a metrics-driven checklist.
• PharmarH had a tracheostomy and even though it’s documented, they always ask him or her to call them.
• Jill loves that the pediatric office where she takes her kids has transformed into a patient-centered medical home that offers same-day appointments and makes it a point to obtain the hospital’s infant records before the first visit.
• My recent experience with the front-office staff of my single-doc PCP (my first visit with her) was unimpressive with their indifference paired with inefficiency, both plainly obvious, and I questioned the choice of playing country music in the waiting room. I was herded off to the exam room a few minutes behind schedule and was told I was the next patient, but I still waited 75 minutes. I was about ready to walk out when the doctor wheeled in a mobile cart running Practice Fusion, apologized for the wait, cheerily introduced herself by first name with a big smile, and asked for and told stories (“I love stories,” she said) in wanting to hear my medical history as a narrative to which she listened intently without focusing on the laptop and she related the experience of other patients. It was a “getting to know you” session that was probably 10 percent relevant to my immediate medical needs (getting routine annual lab tests), but I left a big fan without feeling like a patient widget in her medical factory. It was almost like corralling a doctor at a party who actually wanted to chat about my medical needs. I suspect her documentation of my encounter (which lasted nearly an hour) was skimpy, but I have no doubt she will remember all the important parts regardless.

New poll to your right or here: do you expect the business if your employer under a Trump presidency to be better or worse? Click Comments after voting to explain.

The Greatest Generation of World War II is mostly gone now, but taking its place at the head of the next-to-die line is the ever-dwindling roster of the Greatest Entertainment Generation of the 1960s, as evidenced by last week’s death of poet-musician Leonard Cohen and “Man from UNCLE” Robert Vaughn, PhD. The cool thing about 1960s TV stars is that they hustled on whatever shows hired them for next to nothing, so you can spot them as small players on shows ranging from “The Twilight Zone” to “Wagon Train.” Unlike the rest of us, their digitally preserved work lives on forever and earns news fans daily, allowing people to feel irrationally but happily connected to an impossibly youthful Napoleon Solo forever fighting THRUSH and charming mini-skirted mods with suave indifference.

Last Week’s Most Interesting News

• Siemens announces plans to take its Healthineers medical business public.
• Experts and amateurs alike try to forecast the healthcare impact of the presidential election win of Donald Trump.
• McKesson confirms the layoff of 60 employees of its Charlotte, NC-based Enterprise Information Solutions business that includes Paragon, for which it previously took a $290 million write-down and expressed hopes of selling the business.
• Walgreens files a $140 million breach of contract lawsuit against lab company Theranos.
• ECRI Institute get a $3 million, three-year to study optimization of EHRs and avoidance of patient harm.

Webinars

None scheduled soon. Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Here’s the video of one of our webinars from last week, “CMIO Perspective on Successful 25-Hospital Rollout of Electronic Physician Documentation.”

Acquisitions, Funding, Business, and Stock

Patient education vendor PatientPoint acquires MedCenterDisplay, which offers digital signage, apps, and marketing solutions.

Decisions

• Ellenville Regional Hospital (NY) will switch supply chain software from Medhost to Jump Technologies in February 2017.
• Cameron Memorial Community Hospital (IN) went live on Infor supply chain management in October 2016.

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

People

Virtual doctor visit provider MDLIVE hires Scott Decker (HealthSparq) as CEO, replacing demoted founder Randy Parker.

Government and Politics

President-Elect Trump moderates his previously scathing opinions of the Affordable Care Act, which he had promised to scuttle on his first day in office, and says he wants to keep the elimination of pre-existing conditions and the ability for parents to leave their children on their policies for extra years. He (hopefully) appears to be moderating his over-the-top and ultimately successful election hyperbole with more thoughtful actions. A Washington Post opinion piece describes the problems involved with replacing Obamacare:

To guarantee that people with pre-existing conditions can get affordable health insurance, you need to have rules requiring guaranteed issue and community rating. To keep insurance companies in business because of guaranteed issue and community rating, you need to have an individual mandate. And because poor people can’t afford health insurance, you need subsidies. Combine all three, and what you have, in a nutshell, is … Obamacare … Of course, if you want to scrap guaranteed issue, scrap community rating, scrap the individual mandate, and scrap the subsidies, as Republicans, propose, then you end up where the country was in 2008—with a market system that inevitably gives way to an insurance spiral in which steadily rising premiums cause a steadily rising percentage of Americans without health insurance … you can’t have all the good parts of a socialized system (universal coverage at affordable prices) without freedom-reducing mandates and regulations and large doses of subsidies from some people to other people. Anyone who says otherwise – anyone promising better quality health care at lower cost with fewer regulations and lower taxes—is peddling hokum.

President-Elect Trump announces that his HHS transition advisor will be Andrew Bremberg, JD, who served as HHS special assistant and chief of staff from 2001 to 2007.

A Washington Post opinion piece explains why the author will never join AARP – the organization is a powerful Washington lobbyist that claims to protect Medicare and Social Security while it actually “prevents any serious discussion of meaningfully reforming these programs, which are in great danger of becoming insolvent.”

Privacy and Security

From DataBreaches.net:

• An IT recruitment site announces that an unnamed person accessed one of its development servers that it later determined had not been properly secured by its contractor Capgemini, exposing the information of its job seekers to the Internet. The UK file alone contained the information of 780,000 people, with the possible total exposure being in the millions or tens of millions.
• An encrypted laptop containing the information of over 1,200 members of the Indiana Health Coverage program is stolen from the car of an HP Enterprise Services employee, but HPE disabled it remotely.
• Vanderbilt University’s counseling center exposes the contact information of 468 of its clients to each other when an employee emails a survey using :CC rather than :BCC.
• Kaiser Permanente notifies 8,000 members that a website upgrade’s new caching mechanism could have exposed their information to other people visiting the website at the same time.
• A Texas dermatology practice is hit with ransomware that the practice says it was able to remove.

Other

The local paper features a fun look back at Atomedic Hospital, the 1950s “futuristic hospital for the atomic age” for which prototypes were installed at demonstration sites, most notably the 1964 World’s Fair. The windowless, round, nuclear powered, and modularly constructed 28-bed hospital had an outer corridor for visitors, an inner circle for patient rooms, and a central core for services such as the OR, with patient rooms having doors at either end to allow moving them to the ICU within the central core. The low-cost, pre-packaged hospital was designed to make healthcare affordable. Patients would be served warmed frozen dinners with disposable dinnerware and disposable linen eliminated the need for a laundry. I Googled and found the Atomedic Foundation, which seeks to preserve the idea of quickly constructed, low-cost hospital buildings as envisioned by the original concept. Kaiser Permanente ran a history of the Atomedic Hospital idea last year even though it passed on the idea in 1961, mostly likely because of its high expense at $19,000 per bed and, perhaps most importantly, the fact that the federal government’s Hill-Burton program wouldn’t pay for it as they did for most of the hospital buildings that were erected in the 1960s.

Cerner participates in a study of 82 employee volunteers who turned over their DNA sequencing to the company, signaling Cerner’s continued interest in broadening its reach to healthcare service delivery.

In England, a doctor is jailed for possession of child pornography, which he attempted to hide by occasionally throwing his computers into a river.

Netsmart honors its veteran employees on Veterans Day with a nicely done video.

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 11/11/16

Siemens plans public listing of healthcare business

Siemens announces plans for an IPO of its $15 billion Siemens Healthineers medical business.

Red Hat mHealth survey shows strong ROI and anticipated growth despite budget headwinds

A Red Hat survey of healthcare organizations finds that 82 percent have a fully implemented mobile strategy, outperforming commercial enterprises. 78 percent of those healthcare organizations also report an ROI on their mobile app investments.

VA to launch online appointment scheduling

The VA will begin offering online appointment scheduling in January 2017, starting first with primary care appointments, and then followed by mental health, optometry, and audiology appointments.

‘The polls clearly got it wrong’: The autopsy will take months

Experts say that understanding how statisticians got the election polling forecasts so wrong will take approximately six months of analysis.

News 11/11/16

Top News

Siemens will IPO its $15 billion Siemens Healthineers medical business, offering an unspecified stake while remaining a long-term majority shareholder.

Siemens CEO Joe Kaesar says Healthineers has gone from “good to great” by allowing it to focus and the IPO will “make it a fascinating business.” He says the company will invest in molecular diagnostics and consulting services.

Siemens Healthineers is the German conglomerate’s most profitable business unit. It offers medical imaging, laboratory diagnostics, point-of-care testing, therapy systems, imaging and laboratory diagnostics software, and services.

Reader Comments

From Dell EMC Spokesperson: “Re: Fairview Health Services. The City Pages article was inaccurate and misleading across a wide range of facts, including the comments relating to the Dell EMC products. The Dell EMC products never went down or failed at any point. XtremIO was not the root cause of any incidents referenced in the article. Dell EMC values its strong partnership with Fairview and to serving as a top trustworthy and dependable partner from a technology, support, and strategic IT relationship perspective."

From Lever Puller: “Re: your article on election analytics. I loved it – you nailed down many reasons polls should be taken with a grain of salt. The media should take blame, too, for spending so much energy vilifying the eventual winner so that anyone who wanted to vote for him wouldn’t admit that to pollsters, throwing off their results.” Media people do indeed have their own agendas despite their claims of impartiality and they didn’t try very hard to hide it this time (that’s a big no-no when trying to gauge rather than influence opinion). My takeaways: (a) don’t believe any survey, clinical study, or product ranking until you’ve reviewed its methodology and the motivations of the authors; (b) choose carefully the people you allow to feed you predigested conclusions, especially if you plan to take important action from what they tell you; and (c) follow the money because the biases held by most companies and people are directly linked to their wallets. I’ll also add that actions are more important than words, so when a patient says they are medication-compliant or a company boasts that they have only ecstatic customers, ask to see their data proving it. What I was really saying in that article is that no amount of analytical firepower, even when correctly applied, can reliably predict the behavior of humans, especially when it pertains to their health. Meanwhile, if you really believe what people say instead of what they actually do, you should buy shares in UHAL and make a fortune from all the hand-wringers who swear they’re moving to Canada.

Meanwhile, polling expert Nate Silver says in an analytics debrief, “We got a lot of crap for pointing out that the polls showed a fairly close election and that a fairly ordinary polling error could shift the Electoral College to Trump. People just didn’t want to hear it,” adding that the actual polls weren’t too far off in predicting the popular vote that Clinton won so far (Arizona, Michigan, and New Hampshire apparently ran out of fingers and toes and are still counting). The Huffington Post, which gave Clinton a 98 percent chance of beating Trump, has apologized to Silver for criticizing his projections as the news site earned its permanent place in the digital Dewey vs. Truman spotlight.

From Survey Says: “Re: your article on election analytics. As always, quite good and spot on. You would think a bad miss like Election Night would drive both some introspection and hesitancy to pontificate. I suppose nature abhors a vacuum and people have space on their sites that needs fresh content.” I’m already tired of self-proclaimed health experts confidently telling us what to expect from a Trump presidency, even trying to fine-tune their fuzzy crystal balls down to the level of health IT while barely holding back their post-election bitterness and fear. Some of them appear to simply be parroting each other judging from the identical ideas and similar wording.

HIStalk Announcements and Requests

Today (Friday) is Veterans Day, which we set aside to honor everyone who has served in the US armed forces. If you spent time in uniform on US soil or elsewhere, in a combat role or not, thank you. Every service member experiences sacrifice, time away from family, the possibility of personal harm, and some degree of opportunity cost.

I was thinking about people who are said to have “died suddenly” versus the possibly more accurate “died unexpectedly,” although I’m not sure either phrase is any better than just “died.” Nobody knows when they’re going to die other than executed prisoners and suicide victims, so it’s otherwise always sudden and never expected.

This week on HIStalk Practice: Coordinated Care Oklahoma Chief Administrative Officer Brian Yeaman, MD gets excited about analytics and image sharing. Texas Association of Business CEO stumps for telemedicine. SRSsoft adds InteliChart tech to its practice software for specialists. ONC’s annual report to Congress shows patient engagement office progress. Practice Fusion receives funding from Orix Growth Capital. Glendale MRI Administrative Director Pamela Fletcher speaks to the value of pricing transparency when it comes to keeping up with the competition. BCBS of Kansas offers value-based contracts to Aledade Kansas. Jonathan Bush weighs in on next administration’s impact on healthcare. Northwest Physicians Network CEO Rick MacCornack highlights the value found in working with small technology startups.

Webinars

None scheduled soon. Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Here’s the recording of this week’s webinar titled “How to Create Healthcare Apps That Get Used and Maybe Even Loved.”

Acquisitions, Funding, Business, and Stock

Agfa’s board will enter non-exclusive discussions with CompuGroup Medical about being acquired. CGM’s CFO said Wednesday, “It’s either up or out (for the hospital information system business). If you wanted to step up and become a high-profitability, high-growth player, the position that our friends in Agfa have would be the number one choice.” Meanwhile, I’m pondering why Agfa’s logo lists the company’s name twice.

Sunquest acquires Sandy, UT-based UniConnect, which offers software for molecular laboratories.

Sales

Carrus Hospital (TX) selects Nuance Power PDF to create, convert, and assemble PDF files.

Banner Health Network (AZ) chooses Evolent Health’s care performance management platform.

People

Mike Tarwacki (Forte Research Systems) joins Ability Network as SVP of sales.

Announcements and Implementations

A Red Hat survey finds that 82 percent of large healthcare organizations have fully implemented a mobile strategy, a much higher rate than non-healthcare business, and 80 percent of them say their ROI is positive. However, budgets aren’t keeping up with their development and maintenance plans. The biggest reported technical challenges are back-end integration and securing data access.

Government and Politics

A Health Affairs article says a Donald Trump presidency with Republican control over both houses can’t immediately kill the Affordable Care Act despite the President-Elect’s statement that he will ask Congress for its repeal the day he takes office. The article notes that such a proposal would likely be stopped by a Senate filibuster and adds that the ACA is so deeply ingrained into Medicare and other programs that it can’t simply be rolled back. However, funding for specific parts of “Obamacare” could be cut off, preserving features like coverage of pre-existing conditions, elimination of lifetime dollar caps, and age underwriting restrictions intact but leaving insurers to deal with their financial implications. The newly elected president will also need to quickly replace HHS’s many political appointees with people who might choose not to enforce regulatory requirements and could make it easier for states to pull out completely. The administration could also elect to drop its defense of ACA-related lawsuits, which could, as an example, immediately halt cost-sharing reduction payments to insurance companies in making marketplace participation undesirable to eliminate participation. Experts seem to agree that there’s little doubt that the Obamacare portion of the ACA will go away, with no firm proposals on the table to replace the health insurance carried by 20 million people.

Meanwhile, ACA sign-ups hit record levels the day after the election as people fretted less about skyrocketing premiums and more that the pre-existing condition policies could come back and leave them uninsurable.

Anad Sharma, the founder of iPhone health tracking app vendor Gyroscope, is among a group of California technology company executives who say they’ll financially back the so-called #Calexit fringe movement in which California would secede from the US in protest of Donald Trump’s election.

Former bad boy pharma exec Martin Shkreli follows through on his promise to publicly play his $2 million, one-copy-only Wu-Tang Clan album if Donald Trump were to win the election, calling Trump’s victory “fantastic.”

The VA will launch online appointment scheduling in January 2017, using a system developed internally by the VA along with Accenture Federal Services.

Privacy and Security

From DataBreaches.net:

• Broward Health (FL) is notified by law enforcement authorities that its patient facesheets were found at the home of an unidentified individual.
• The Eastern Colorado VA system says the names and diagnoses of 2,100 veterans were exposed when one of its employees emailed unencrypted documents to her personal email account.
• In Canada, the privacy commissioner of Newfoundland and Labrador orders Eastern Health to implement mandatory user log-outs and to consider proximity-based security after someone accesses patient information using the still-active Meditech session of a doctor who had left the area for rounds.

Other

The Madison paper covers a new bus service that targets Epic commuters with hardwood floors, free coffee, Wi-Fi, and a widescreen TV.

The USDA celebrates Allene Rosalind Jeanes, PhD (1906-1995), an agricultural chemist who was asked by a soft drink company to figure out why a batch of its root beer had thickened, leading her to develop a manufacturing process for the life-saving plasma substitute dextran. She and her team also discovered xanthan gum, used to thicken ice cream, medicines, and other products.

Weird News Andy is ‘appy this didn’t ‘appen in England since “first, do no ‘arm” wouldn’t be convenient. A plastic surgeon in China grows an artificial ear on a man’s arm that will eventually replace the one he lost in an accident.

Sponsor Updates

• Valence Health will exhibit at the AMGA Institute for Quality Leadership November 15-17 in San Francisco.
• Verscend will exhibit at the NHCAA Annual Training Conference November 16-19 in Atlanta.
• Optimum Healthcare IT is mentioned positively in the KLAS Healthcare Consulting 2016 report.
• Group health extends its ZeOmega contract and will upgrade to the latest version of its Jiva population health platform.
• ZirMed will exhibit at Wave 2016 November 17-18 in Austin.
• Hilo Medical Center (HI) moves procedure consents to Web-based forms and electronic signatures from Access.
• Zynx Health will exhibit at Cerner Health Conference 2016 November 12-16 in Kansas City, MO.
• Sunquest will exhibit at the Association for Molecular Pathology Annual Meeting November 10-12 in Charlotte, NC.
• Consulting Magazines names Impact Advisors VP Jenny McCaskey one of the “Women Leaders in Consulting” of 2016.
• NCQA recertifies 17 Medecision disease management programs.
• Imprivata, National Decision Support Company, and MedCPU will exhibit at Cerner Health Conference 2016 November 14-17 in Kansas City, MO.
• LogicStream Health will host a networking event for Cerner Health Conference attendees November 15 at the Drum Room.
• InterSystems will exhibit at AMP’s annual meeting November 10-12 in Charlotte, NC.
• Intelligent Medical Objects, Meditech, and Streamline Health will exhibit at the AMIA 2016 Annual Symposium November 12-16 in Chicago.
• Kyruus will host its annual ATLAS Conference November 14-15 in Boston.
• The Kansas City Business Journal profiles Netsmart.
• Obix Perinatal Data System will exhibit at the HIMSS Midwest Fall Technology Conference November 13-15 in Bloomington, MN.
• Experian Health will exhibit at HFMA North Dakota November 12-13 in West Fargo.
• The SSI Group will exhibit at the 2016 HFMA Mid-Atlantic Region Meeting November 13-16 in Asheville, NC.
• SK&A publishes a new report, “Top 50 Free-Standing Surgery Centers.”

Blog Posts

• What is Ransomware and How to Protect Against It (TierPoint)
• Key Takeaways from the CHIME 2016 Fall CIO Forum (Infor)
• Let’s get it started! (Voalte)
• Choosing the Right SMS Provider 4 U (West Corp.)
• A Legacy of Care: Honoring Hospital Contact Center Operators (Spok)
• Top 5 Ways to Reduce and Manage Medical Necessity Denials (ZirMed)
• Assessing Data Breach Severity: Third-Party Incident Exposes Credit Card Data (ID Experts)
• Online Reviews Impact How Patients Select Hospitals and Doctors (Influence Health)
• And the Winner of the 2016 Election is … Big Data (Liaison Healthcare)
• Happy Employees Make Happy Patients (MedData)
• Countdown: Top 5 Reasons to Provide Price Estimates (Navicure)
• Gathering and Storing Healthcare Information: The First Step in the Journey Towards Integrated Care (Orion Health)
• Plug-in Payments: Why Practices Should Integrate Their Hardware, Software, and Processing Agreement into a Single Technology Platform (Patientco)
• Back from the Honeymoon (PeriGen)
• Leveraging SharePoint and Project for Collaborative Project Planning (Summit Healthcare)

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 11/10/16

Most of the physicians I have interacted with over the last two days have commented about potential healthcare impacts from Tuesday’s election. Although the potential repeal of the Affordable Care Act was at the top of multiple conversations, there were many local and state questions with a health-related focus.

Colorado voters failed to pass Amendment 69, which would have allowed for a single-payer healthcare program to replace the state’s insurance exchanges and also private plans. Voters there approved Proposition 106, which would allow physicians to prescribe lethal drugs to terminally ill adults who are certified by at least two physicians as having less than a six-month life expectancy. Colorado voters also said no to increased tobacco taxes, with similar rejections in North Dakota and Missouri. The latter had two tobacco tax issues on the ballot, which likely caused confusion.

Regarding other smoking options, medical marijuana was legalized in Arkansas, Florida, and North Dakota, while Montana amended its existing regulations. Recreational marijuana use was approved in California, Maine, Nevada, and Massachusetts. Those eager to partake will have to wait a bit longer while states finalize the details around the actual sales and dispensary processes.

California voters approved a tax of one cent per ounce on sugar-laden drinks in Oakland, San Francisco, and Albany, while voters in Boulder, Colorado approved a two cent tax. California voters also elected to continue fee assessments on private hospitals, with the proceeds being used to fund Medicaid.

The most interesting ballot questions I saw were in Florida, with two non-binding referendums on the release of genetically modified mosquitoes to reduce disease. It’s an interesting idea as a public heath intervention and passed in Monroe County, but not in Key Haven. I’m a big fan of Jurassic Park and I can’t help but wonder if voters thought about what happened with those genetically modified dinosaurs when they made their decisions.

California was certainly a leader in the number of health-related questions, although voters failed to pass Proposition 61, which would have blocked pharmaceutical companies from charging state payers more than they charge the Department of Veterans Affairs. Not surprisingly, big pharma spent more than $100 million to oppose the measure.

Although the president-elect promised to repeal the Affordable Care Act as part of his platform, Republicans failed to earn a filibuster-proof majority in the Senate. The ACA was a long time in the making and had support from both sides of the aisle, so efforts to reverse are sure to be interesting. Filibusters are always attention-grabbing as well as a way to hear some interesting literature and potentially pick up some new recipes.

There is a chance that a budget reconciliation maneuver might be used, which only requires a simple majority, but this requires a review of the parliamentary process around budgeting to ensure that the process is compliant. This process was used earlier this year, but the bill ultimately suffered a Presidential veto.

Changing the ACA might be more difficult than people think, as more than 20 million people would stand to lose insurance coverage. Additionally, many Americans have been pleased with the portions of the law that protect patients with pre-existing conditions and extend the length of time that dependents can remain under their parents’ coverage. This enthusiasm has been tempered, however, by concerns over high coverage costs and rising premiums.

Trump has also mentioned allowing the import of prescription drugs from outside the US, as well as allowing Medicare to negotiate drug pricing directly with pharmaceutical manufacturers. Similar efforts have been blocked by the GOP in the past, so it will be interesting to see what’s different this time. It’s likely that a Republican-controlled legislature will take up the issue of funding for Planned Parenthood and perhaps other regulations related to reproductive healthcare.

The issue of filling the existing vacant Supreme Court spot was also the topic of several discussions. I’m sure the nomination process will be interesting once our new president takes office. We’re certainly in for an interesting ride over the next several months.

What chatter are you hearing about the future of healthcare after the election? Email me.

Email Dr. Jayne.

Morning Headlines 11/10/16

Policy experts say quick repeal and replace of ACA unlikely

Health policy experts say that despite GOP control of the White House, Senate, and House of Representatives, and persistent promises from Congress to repeal or replace, a full repeal of ACA remains unlikely due to the simple fact that millions of Americans would lose their health insurance.

Cerner, HCA stocks dip with ACA uncertainty

On the stock market, healthcare stocks are slipping on uncertainty around a potential ACA repeal. Cerner stock fell 4.6 percent overnight, while HCA’s stock price fell 12.4 percent.

Kaiser Foundation Health Plan and Hospitals Report Year-to-Date and Third Quarter 2016 Financial Results

Kaiser Permanente reports Q3 results: revenue grew to $48.3 billion, resulting in $672 million in operating income, up from $363 million for the same quarter last year.

How some hospitals are replacing pricy EpiPens with a $10 version

In response to increasing EpiPen prices, the University of Utah Health Care system is replacing EpiPen’s within the system with a $10 EpiKit, which will include a vial of epinephrine, two needles, alcohol wipes, two syringes, and instructions.

The Election Lesson Learned is to be Healthily Skeptical of Analytics

The Election Lesson Learned is to be Healthily Skeptical of Analytics
By Mr. HIStalk

It was a divisive, ugly election more appropriate to a third-world country than the US, but maybe we can all have a Kumbaya-singing moment of unity in agreeing on just one thing – the highly paid and highly regarded pollsters and pundits had no idea what they were talking about. They weren’t any smarter than your brother-in-law whose political beliefs get simpler and louder after one beer too many. The analytics emperors, as we now know, had no clothes.

The experts told us that Donald Trump was not only going to get blown out, but he also would drag the down-ballot candidates with him and most likely destroy the Republican party. Hillary Clinton’s team of quant geeks had it all figured out, telling her to skip campaigning in sure-win states like Wisconsin and instead focus her energy on the swing states. The TV talking heads simultaneously parroted that Clinton had a zillion “pathways to 270” while Trump had just one, an impossible long shot. The actual voting results would be anticlimactic, no more necessary to watch than a football game involving a 28-point underdog.

The (previously) respected poll site 538 pegged Trump’s chances at 28 percent as the polls began to close. Within a handful of hours, they gave him an 84 percent chance of winning. Presumably by Wednesday morning their finely tuned analytics apparatus took into account that Clinton had conceded and raised his chances a bit more, plus or minus their sampling error.

This morning, President-Elect Trump is packing up for the White House and the Republicans still control the Senate. Meanwhile, political pollsters and statisticians are anxiously expunging their election-related activities from their resumes. They had one job to do and they failed spectacularly. Or perhaps more accurately, their faulty analytics were misinterpreted as reality by people who should have known better.

Apparently we didn’t learn anything from the Scottish referendum or Brexit voting. Toddling off to bed early in a statistics-comforted slumber can cause a rude next-day awakening. Those darned humans keep messing up otherwise impressive statistics-powered predictions.

We talk a lot in healthcare about analytics. Being scientists, we’re confident that we can predict and maybe even control the behavior of humans (patients, plan members, and providers) with medical history questionnaires, clinical studies, satisfaction surveys, and carefully constricted insurance risk pools. But the election provides some lessons learned about analytics-powered assumptions.

• It’s risky to apply even rigorous statistical methods to the inherently unpredictable behavior of free-will humans.
• Analytics can reduce a maddeningly complex situation into something that is more understandable even when it’s dead wrong.
• Surveyors and statisticians are often encouraged to deliver conclusions that are loftier than the available data supports. We humans like to please people, especially those paying us, and sometimes that means not speaking up even when we should. “I don’t know” is not only a valid conclusion, but often the correct one.
• Be wary of smoke-blowing pundits who suggest that they possess extra-special insight and expertise that allow them to draw lofty conclusions from a limited set of data that was assembled quickly and inexpensively.
• Sometimes going with your gut works better than developing a numbers-focused strategy, like it did for Donald Trump and for doctors who treat the patient rather than their ICD-10 code or or lab result.
• Confirmation bias is inevitable in research, where new evidence can be seen as proving what the researcher already believes. The most dangerous bias is the subconscious one since it can’t be statistically weeded out.
• A study’s design and its definition of a representative sample already contains some degree of uncertainty and bias.
• Sampling errors have a tremendous impact. We don’t know how many “hidden voters” the pollsters missed. We don’t know how well they selected their tiny sampling of Americans, each of whom represented thousands of us who weren’t surveyed. Not very, apparently.
• Response rates and method of outreach matter. Choosing respondents by landline, cell phone, email, or regular mail and even choosing when to contact them will skew the results in unknown ways. Most importantly, a majority of people refuse to participate entirely, making it likely whatever cohort they are part of leaves them unrepresented in the results.
• You can’t necessarily believe what poll respondents or patients tell you since they often subconsciously say what they think the pollster or society wants to hear. The people who vowed that they were voting for Clinton might also claim that they only watch PBS and on their doctor’s social history questionnaire declare their unfamiliarity with alcohol, drugs, domestic violence, and risky sexual behaviors.
• Not everybody who is surveyed shows up, and not everybody who shows up was surveyed. It’s the same problem as waiting to see who actually visits a medical practice or ED. Delivering good medical services does not necessarily mean effectively managing a population.
• Prediction is best compared with performance in fine-tuning assumptions. The experts saw a few states go against their predictions early Tuesday evening, and at that moment but too late, applied that newfound knowledge to create better predictions. Real-time analytics deliver better results, and even an incompetent meteorologist can predict a hurricane’s landfall right before it hits.

It’s tempting to hang our healthcare hat on piles of computers running analytics, artificial intelligence, and other binary systems that attempt to dispassionately impose comforting order on the cacophony of human behavior. It’s not so much that it can’t work, it’s that we shouldn’t become complacent about the accuracy and validity of what the computers and their handlers are telling us. We are often individually and collectively as predictable as the analytics experts tell us, but sometimes we’re not.

Readers Write: Don’t Get Stuck in the Readmissions Penalty Box

Don’t Get Stuck in the Readmissions Penalty Box
By Lisa Lyons

The Hospital Readmissions Reduction Program (HRRP) requires the Centers for Medicare and Medicaid Services (CMS) to reduce payments to inpatient hospitals with relatively high 30-day readmission rates. CMS applies up to a three percent reduction for “excess” readmissions using a risk-adjusted ratio that compares a hospital’s performance to the national average for sets of patients with specified conditions.

Payment adjustments for FY 2017 (based on performance from July 2012 through June 2015) will be applied to all Medicare discharges starting October 1 of this year and running through September 30, 2017. Payment reductions for FY 2017 will be posted on the Hospital Compare website this October.

Total HRRP penalties are expected to reach $528 million for FY 2017, up sharply from about $420 million in FY 2016, with more than half of the nation’s hospitals affected, according to a Kaiser Health News analysis. The average penalty will spike in similar fashion, from 0.61 percent in FY 2016 to 0.73 in FY 2017.

The situation calls for a thorough understanding of the readmissions penalty environment and a strategic mindset for taking action.

Prior to FY 2017, CMS measured excess readmissions by dividing a hospital’s number of “expected” 30-day readmissions for heart attack, heart failure, pneumonia, hip/knee replacement, and COPD by the number that would be expected, based on an average hospital with similar patients.

For FY 2017, CMS expanded the list of cohorts to include coronary artery bypass graft (CABG) procedures. The agency also added to the existing pneumonia cohort: the assignment criterion now includes cases where the principal diagnosis of non-severe sepsis includes secondary diagnosis of pneumonia and aspiration pneumonia. This creates a bigger set of patients from which a hospital could have readmissions — in fact, it may expand the pneumonia cohort by 50 percent in many hospitals.

Complicating matters, excess readmissions found in any of the six cohorts will result in an overall penalty. A hospital gets no credit for making readmissions improvements along the way.

At the same time, all hospitals are working on readmissions, so the average of excess readmissions is decreasing. That means it’s harder than ever for hospitals to stay under the penalty bar.

Also, due to HRRP’s reporting cycle, an excess readmission stays in CMS’s data for three years.

These factors make it hard for hospitals to know if they have passed the tipping point for readmissions penalties before notification from CMS — which typically happens just four months prior to penalties being imposed. In practical terms, there’s not enough time to impact results.

Further, analyzing CMS data is challenging for most hospitals because:

• CMS data is retrospective. CMS calculates fiscal year penalties by looking back at data over a range of two to five years. As such, current improvements to readmission reduction programs will not be seen right away.
• CMS data includes readmissions from “non-same” hospitals. Most hospitals can’t view cases where a patient initially admitted to their facility ended up being readmitted in another facility.
• CMS data only includes readmissions among the Medicare patient population. Many commercial payers have instituted pay-for-performance programs, which should also be analyzed. Limiting your view to the Medicare HRRP program will only reveal part of your overall readmissions.
• CMS’s Measure Methodology for Readmissions can’t be easily replicated. CMS risk-adjusts each qualifying patient using Medicare Part A and Part B data for a full year prior to admission, and 30 days post-discharge. Since hospitals don’t have access to this information, they can’t replicate the methodology to calculate their excess readmissions.

Fortunately, with the right data, there’s a way to emulate the CMS methodology to help estimate the volume of excess readmissions that will be attributed to your hospital. You can do so well before receiving your hospital-specific reports from CMS.

Here are four ways advanced analytics can help position hospitals to be more proactive in managing their readmissions:

1. Purchase de-identified Medicare Part A and B claims data from CMS. Advanced analytics makes it possible to match historic claims data with known patients in your hospital information systems. In this way you can see longitudinal care histories for the patients you are discharging today. Algorithms can also predict the rate of non-same hospitalization from current readmission data, effectively filling in the blanks on readmissions that occur outside your hospital. That may give you up to two years advance notice regarding which readmissions will be counted as excessive. With that knowledge, you can do something about readmissions before the end of the evaluation period.
2. Know how many readmissions will put you in jeopardy of incurring penalties. This is the previously mentioned tipping point. Surprisingly, for many hospitals, only a few excess readmissions per month can send them to the penalty box. Predictive analytics identify patients at greatest risk for unplanned readmissions. Look for algorithms with a high degree of accuracy in matching the CMS dataset to your own database to single out cases that were identified in the assignment criteria. Once you’re able to identify trends, you can fix the issues.
3. Since CMS measures readmission back to any hospital, partner with other hospitals in your region to which you commonly refer patients back and forth. Concentrate on areas of improvement in either coordination or quality of care.
4. Analyze clinical conditions across the board among your hospital’s patient population, not just within the six CMS-defined cohorts. Taking a broader view establishes more effective data patterning to help determine if a systemic problem exists. Dashboards and pre-formatted reports signal where to drill down for more detail (for example, whether you discharged the patient to home or a different care setting).

Government policy statements clearly indicate Medicare payments becoming more heavily weighted on quality or value measures, and HRRP will be part of that determination.

What’s more, CMS has proposed that the readmission measure itself be expanded to count excess days associated with readmissions — taking into account ED patients and those assigned to observation status — rather than singular readmission events for inpatients. Expect increased involvement of care management and quality teams in this area, and another layer of potential penalties.

Don’t wait to react to how these measures will impact your hospital’s operations and finances. Now’s the time to implement data analytics tools to intelligently manage your hospital’s readmission risk with a high degree of accuracy.

Lisa Lyons is director of advanced analytics and population health and interim VP of consulting at Xerox.