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Monday Morning Update 10/31/22

October 30, 2022 News 1 Comment

Top News

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Teladoc Health reports Q3 results: revenue up 17%, EPS –$0.45 versus –$0.53, beating Wall Street expectations for both.

TDOC share price moved up on the news, although it remains down by 81% in the past 12 months. The company’s market cap is under $5 billion versus its all-time high of $45 billion in early 2021.

The company reports strong performance of its direct-to-consumer BetterHelp mental health business. It says it lost a former client of Livongo, which Teladoc acquired for $18.5 billion in October 2020.

Teladoc says that it is getting increased interest from organizations who want to use virtual health to manage chronic conditions at a lower cost.


Reader Comments

From Lomond: “Re: Cerner. Which of its missteps led to its sale to Oracle?” Cerner struggled with product issues (such as revenue cycle), dated architecture, and a client base that was being constantly poached by Epic. Multi-billion dollar federal contracts stretching over decades weren’t enough to keep investors excited. However, Cerner’s biggest mistakes were made by its board, who took forever to choose a successor when Neal Patterson died in 2017 despite the claimed existence of a CEO succession plan, which surely didn’t tell board members to, “Hire a low-profile CEO of a division of a foreign medical device manufacturer for his first real CEO job.” But to be fair, a lot of Cerner executives who should have been likely candidates, especially those who Neal didn’t like much, had already successfully moved on. Brent Shafer’s four years were forgettable except for the board’s capitulation to an activist investor, then the board hired as Shafer’s replacement yet another executive who had never run a publicly traded company, although maybe David Feinberg made Cerner look hipper to eventual acquirer Oracle in his fantastically lucrative few weeks as CEO. Looking ahead, I can’t think of many examples where acquired health IT companies got better running as divisions of unrelated companies whose own growth prospects were questionable, but Oracle is saying and doing all the right things so far. Boards have a fiduciary responsibility to investors and I think they chose the best available option in this case. It’s all great news for Epic, which at some point will have its own CEO succession plan tested in the same way.


HIStalk Announcements and Requests

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Two-thirds of poll respondents had paid their co-pay by the time they left their ambulatory visit. My personal experience is that medical practices and clinics are much worse at upfront collection than dental practices, which always seem to know exactly how much you need to pay after insurance and nicely ask for that payment while you’re taking possession of your free toothbrush kit.

New poll to your right or here: In the past year, has a provider given you a blank paper or electronic form that asks for information they should already have on file? It is aggravating when the front desk people of a provider that you’ve been seeing all along ask for the same information that they have already collected – medical history, allergies, meds list, emergency contact, etc. – instead of populating the form and allowing you to provide any corrections or updates. Will someone actually update your EHR information correctly if your new list of allergies or meds doesn’t match what is on file? If not, are you completing the form just so the provider doesn’t have to look at the EHR?

I watched Netflix’s movie “The Good Nurse” and it was a so-so yarn about nurse Charles Cullen, who killed dozens or hundreds of hospital patients using drugs like digoxin and insulin that he obtained by taking advantage of a quirk in the Pyxis drug dispensing machine. The hospital’s stonewalling of the police investigation was a big part of the movie, but what should have been mentioned was that many hospitals were irresponsibly using Pyxis like candy machines in the early 2000s, allowing nurses to make withdrawals of unordered meds, storing drugs in shared drawers (Cullen punched in Tylenol, then took digoxin from the same shared drawer), and failing to audit what was taken versus what was charted as given. i wrote a daily report ago for my academic medical center employer years ago that identified Pyxis withdrawals of unordered meds (including logic to account for delayed order entry), and it was so lengthy that nobody would review it. Anyway, the movie recalls the 2017 case of VUMC nurse Rhonda Vaught, who overrode a drug dispensing machine safeguard to give a patient the paralyzing drug vecuronium instead of the ordered sedative Versed, after which the patient died. San Diego-based Pyxis went public in 1992, sold to Cardinal Health for $867 million in 1996, was spun off with other products into Carefusion in 2009, and then was acquired by Becton Dickinson in 2014 for $12 billion.

This is the final boarding call for companies that want to sign up as HIStalk sponsors before the spring conference season begins and you realize that your HIMSS booth doesn’t help you for the 362 other days of the year.


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Welcome to new HIStalk Platinum Sponsor Censinet. The Boston-based company’s cloud-based RiskOps platform and collaborative risk network transforms cybersecurity and enterprise risk in healthcare with the fastest assessment results, most coverage, and best overall experience at a fraction of the cost. Its digital catalog includes 9,500 assessed vendors and 34,000 products and services, offering automated risk ratings and corrective action plan generation to streamline identification and remediation of risks with pre-built workflows. An example is generating a list of vendors and products that have access to PHI but aren’t covered with a business associate agreement. The company offers healthcare organizations no-cost access to its RiskOps for HICP, which simplifies the implementation and assessment Health Industry Cybersecurity Practices. Censinet RiskOps enables health systems to create long-term vendor partnerships, resulting in fewer vulnerabilities, reliable patching, and better performance and compliance overall. Thanks to Censinet for supporting HIStalk.

Here’s a video featuring Censinet founder and CEO Ed Gaudet, who describes the company’s philosophy and product.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

Investor-backed HLTH says it has 9,400 registrants so far for its conference, which will be held November 13-16 in Las Vegas. I was surprised to see HIStalk list as a media attendee since none of us are going.


Sales

  • Three university hospitals in France choose Sectra’s digital pathology solution.

People

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Hearst hires Atti Riazi (Memorial Sloan Kettering Cancer Center) as CIO.


Announcements and Implementations

SNOMED and LOINC will collaborate to standardize health data terminology, distribute their content together, and reduce duplication.

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Fresh Tri, whose app promotes healthy habit formation, updates its system with improved onboarding, new algorithms to match users to behaviors, and new behaviors to support condition and disease management. Walmart licenses the app for free use by its 1.6 million employees.

Spok’s annual healthcare communications survey finds that the top obstacle in hospitals is budget and resources. Smartphone use for clinical communications dropped slightly for the first time, possibly because hospitals are issuing wi-fi phones instead of asking employees to use their own devices.

MUSC Health and MetroHealth launch Ovatient, a non-profit company and care model that will provide virtual and in-home care. The health systems say they hope that Ovatient can match the convenience and experience that non-traditional providers are delivering using digital tools.


Government and Politics

National Oceanic and Atmospheric Administration confirms that it plans to go live on Oracle Cerner next year, although under the Department of Defense’s MHS Genesis project rather than the VA’s as initially reported. NOAA has 24 clinicians.


Privacy and Security

A review finds that Canada’s Newfoundland and Labrador Centre for Health Information was warned that its 40-year-old Meditech Magic system was vulnerable to hackers a year before a fall 2021 ransomware attack exposed patient information and caused treatment delays. NLCHI has been recommending for years that the province issue a tender to replace Magic, with one study projecting that a move to Meditech Expanse would cost $85 million over 10 years, but would more than pay for itself.


Other

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Congratulations to New Jersey health IT consultant Eric Finkelstein, who has broken a Guinness world record for eating at the most Michelin-starred restaurants in 24 hours. He was able to obtain reservations at 18 of New York City’s best restaurants, traveling between them by Citi Bike bicycle and using a body cam to prove his accomplishment in wolfing down each place’s fastest-prep menu items, sometimes in less than two minutes. He spent $500 on his latest Guinness accomplishment, which also includes visiting all Citi Bike docks, making the longest table tennis serve, and building a flag out of 20,000 ping-pong balls.


Sponsor Updates

  • First Databank helps extend adoption of NCPDP’s National Facilitator Model, which will allow pharmacies, prescribers, and government agencies to access real-time information on prescriptions, testing, and immunization.
  • PeriGen CEO Matthew Sappern appears on Alldus International’s AI in Action Podcast.

Blog Posts

The following HIStalk Sponsors will exhibit at and/or sponsor AMIA 2022 November 5-9 in Washington, DC:

  • Clinical Architecture
  • First Databank
  • Intelligent Medical Objects
  • InterSystems
  • Meditech
  • Oracle Cerner
  • Wolters Kluwer Health

Contacts

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

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Morning Headlines 10/28/22

October 27, 2022 Headlines No Comments

NOAA Could Soon Join the VA’s EHRM Program

A VA official says that the 12,000-employee National Oceanic and Atmospheric Administration may join the VA’s Oracle Cerner project.

Navina Raises $22M Series B Round to Advance Its Rapid Transformation of Primary Care With AI

AI-powered, primary care patient insights company Navina raises $22 million in a Series B funding round, bringing its total raised to $44 million.

MHS Genesis Reaches Significant Operational Milestone

Ninety-two military hospitals and clinics are now live on Oracle Cerner-powered MHS Genesis, with half of all DoD providers actively using the system.

News 10/28/22

October 27, 2022 News 5 Comments

Top News

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In England, the British Medical Association’s general practice group warns members of possible unintended consequences of NHS England’s “Data Saves Lives” program that takes effect on November 1. Patients over 16 will be automatically granted access to all of their digital medical records as stored in TPP and EMIS. The same functionality is being developed for practices that use Cegedim.

BMA GPC suggests that practices use a specifically assigned SNOMED code that allows them to protect the information of patients whose relationships put them at risk.

They also note the “poor functionality of current software” that allows redacted records to be automatically activated when the patient changes doctors.

The group says a media campaign is needed to warn the public that their family members can access their records if they know (or can find or guess) their password.


HIStalk Announcements and Requests

The FOMO in me is calling for experimentation with the Meta Quest 2 virtual reality headset, although the cheapskate in me is countering with (a) the strong possibility I wouldn’t achieve ROI because I’ll lose interest; (b) waiting for the follow-up product’s release next year at about the same price; and (c) my reluctance to support Facebook with eyeballs or dollars.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

Google acquires five-employee Sound Life Sciences, which offers an FDA-cleared respiration app for smartphones and smart speakers.

Walmart Health will open 16 new health centers in its Florida Supercenters next year.


Sales

  • PerfectServe chooses Lyniate Rhapsody as a Service for integration.
  • AtlantiCare chooses Orbita’s healthcare virtual assistant and conversational AI platform for digital front door and outbound communications such as post-discharge follow-up and care reminders..

People

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Everbridge hires Sheila Carpenter (Zix) as CIO.

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Karen Luk (AbleTo) joins Vivante Health as SVP of product.

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InteliChart hires Anthony Carter, MSEE, MBA (CloudFran) as COO.

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Victor Bagwell, MPH, MAS, MBA, MSc (Optimal Analytics) joins FDA as division director, Center for Biologics Evaluation and Research, Office of Regulatory Operations.

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Avicena hires Tesia Folse (Gainwell) as VP of marketing.


Announcements and Implementations

UCLA Center for SMART Health and Hearst Health announce the finalists for their $100,000 prize for using data science to manage or improve health:

  • Constant Therapy Health (at-home speech, language, and cognitive therapy).
  • Geisinger (linking people with chronic diseases to clinical services).
  • Prenosis (assessing hospital inpatients for sepsis risk).

A Black Book poll of hospitals and physician practices names AQuity Solutions as highest ranked in virtual scribes, medical transcription, and document capture.

The Massachusetts Medical Society opens submissions for its IT in Medicine awards program for MA-based medical students and residents.

Healthcare Triangle launches a service to help healthcare and life sciences organizations implement Metaverse environments.

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GetWell will enhance its inpatient offering as a consumer-forward solution, including a new user experience, mobile-first solutions, automated caregiver workflow and communications, and further EHR integration.

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Net Health integrates its wound EHR with PointClickCare to support clinical documentation exchange with post-acute healthcare facilities.

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A new KLAS report on home health technology finds that Homecare Homebase is vendor of choice for large, independent organizations even though its user satisfaction is average and innovation lags, largely because it offers broad, well-integrated functionality. Independent agencies rate MatrixCare tops, while health system-owned agencies rank Epic and Meditech highest.


Government and Politics

A VA official says that the 12,000-employee National Oceanic and Atmospheric Administration may join the VA’s Oracle Cerner project.

Politico notes that many state Medicaid programs are declining to pay for remote patient monitoring, either because they question its effectiveness in managing chronic conditions or because they are unwilling to spend the money.


Privacy and Security

Australia’s MediBank says that its October 12 breach was worse than the insurer originally reported, now acknowledging that the hacker had access to all of the personal data of its 4 million customers and significant amounts of their health claims data.

A Meta spokesperson says that use of its pixel user tracking tool to send sensitive information to advertisers, as several leading health systems appear to have done, violates its policies.


Other

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Vanderbilt University Medical Center informatics professor Allison McCoy, PhD questions why practices ask long-term patients to input the information that is already documented in their EHR. I’ll join that bandwagon in observing that providers have always shoved the same literal or virtual clipboard full of poorly designed forms at every patient, long-term or otherwise. Beyond making the patient enter information that’s already on file, that raises the question – how are the two sets of information being reconciled, and by whom? Electronic questionnaires, or more specifically their improper use by practices who fail to tailor their messages, may have made the practice even more annoying. Healthcare interactions are among the most important and most expensive for many of us, so to greet loyal customers with blank faces and blank forms is inexcusable, especially when pharmacies, dental offices, accounting and law practices, banks, and even veterinary offices always make customers feel known and valued.

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An entertainment publication profiles retired ICU nurse Amy Loughren, who helped convict friend and colleague Charles Cullen for killing hospitalized patients by adding lethal drugs that he obtained from Pyxis drug dispensing cabinets to their IVs. The story is dramatized in the new Netflix true crime film “The Good Nurse.” Loughren became suspicious in 2002 about several mysterious patient deaths at Somerset Medical Center (NJ). She looked at Cullen’s activity log in Cerner, which showed that Cullen was monitoring patients who weren’t under his care and some of those patients died unexpectedly. Cullen eventually confessed to murdering dozens of patients, having moved from one job to another at hospitals that declined to notify authorities about their suspicions or to give him a bad employment reference because they were afraid of being sued. In another health IT angle, investigators were initially told that the hospital’s Pyxis system retained records for only two months, but a detective found that information was actually stored indefinitely, which convinced Cullen to confess to the 40 murders that he could remember (the actual number of patient deaths was speculated to be as high as 400).


Sponsor Updates

  • Intelligent Medical Objects will exhibit at NextGen UGM November 6-9 in Nashville.
  • Loyal Health will exhibit at the Healthcare Internet Conference November 7-9 in Miami.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/27/22

October 27, 2022 Dr. Jayne 3 Comments

Hospitals and health systems are often sponsors and supporters of various sports teams. Although I understand the reasons and how marketing works, I’m always annoyed since deep down all that spending is fueled by patients.

One of our local surgeons, who is frankly embarrassed at his organization’s sports sponsorships and luxury suites at the local ballpark, shared this piece about a shakeup in stadium naming rights for one of the newest Major League Soccer teams. Health insurer Centene has backed out of a deal to be the naming sponsor for the newly constructed stadium in St. Louis, where the aptly named St. Louis City SC is set to play. The stadium will now be called Citypark while the team hunts for a new naming sponsor. Centene had previously inked a 15-year deal for the naming rights, but a recent statement to local media said it would be realigning partnerships to create “long-term, tangible value for local communities.”

Millions of taxpayer dollars flow through Centene every year via government programs such as Medicaid, so I’m glad they’re reassessing the use of their funds. Not to mention that recent reports indicate that their Medicare Advantage quality scores have been worse than expected, which places its 2024 revenues at risk. The organization recently announced it plans to hire a chief quality officer. I’d much rather see money spent on that role than to name a sports facility. At the same time, Centene noted that quality improvement will be “a compensation metric by which all employees’ performance will be measured this year.” I hope they set things up to truly incentivize the employees as opposed to making it a way to squeak out more cash for the shareholders.

I admit that I’m suckered in by clickbait headlines as much as the next person, so I felt compelled to click on the recent Medscape feature on “Physicians Behaving Badly: US vs. UK.” I had literally just come off a call with a colleague where we discussed various patient misadventures, including misdiagnosis, failure to receive informed consent prior to a procedure, fraudulent patient care documentation, and more. The survey looked at 2,800 physicians in the US and UK. In case anyone is curious, the US ranked higher in several unseemly behaviors, including being verbally or physically aggressive; disparaging others; using racist language; and bullying and harassment. UK physicians ranked higher in public intoxication. “Making unwanted advances” was a choice in the US survey but not in the UK version, and conversely sexist behavior was a choice in the UK but not in the US, so it was hard to compare the two.

When faced with physician misbehavior, US physicians were more likely to complain anonymously to the employer or human resources, where UK physicians were slightly more likely to do nothing. For both groups, the leading demographic for misbehavior was age 40-49, with men outnumbering women twofold. As far as how those surveyed think physicians should behave, data was almost identical for both the US and UK, with two-thirds thinking that physicians should be held to higher standards than the general public due to their role. I dislike seeing healthcare professionals behaving badly, regardless of their title, role, or geographic location. I’ve seen more training programs addressing professionalism in their curricula, so let’s hope things improve.

If primary care physicians spend more time in the EHR, does that lead to improved clinical outcomes? A study published this week in JAMA Network Open looked at this question. Researchers performed a cross-sectional study of 300 primary care providers at two large academic health centers. They found that each additional 15 minutes of daily use of EHR messaging led to improvements in glucose control for diabetic patients, improved management of hypertension, and higher breast cancer screening rates. Of course, that amount of time sounds small, but over the course of a year, 15 minutes a day adds up to an additional week and a half of work for a clinician who is more likely than not to already be burned out and stressed.

The authors noted that “these results underscore the need to create team structures, examine PCP and office workflows, and enhance EHR-based technologies and decision support tools in ways that enable high quality of care, while optimizing time spent on the EHR.” Since so much of EHR messaging work is not part of a clinician’s visit-based, revenue-generating work, they also note that “the associations we have identified between increased in-basket time and enhanced ambulatory quality of care highlight the importance of continuing to develop and expand value-based reimbursement systems that adequately reward outside-of-visit care delivery.”

They note that both academic health systems in the study have dedicated population health teams that support primary care physicians in tracking quality performance. They’re also both located in the same geographic area that has a relatively heterogeneous patient population, and as such, they may not represent the majority of primary care physicians in the US.

My favorite quote from the piece is this: “Our findings suggest that although increased EHR time, particularly after hours, has been associated with increased emotional exhaustion and burnout, it may represent a level of thoroughness, attention to detail, or patient and team communication that ultimately enhances certain outcomes. This finding is consistent with recent research reporting a trend toward better outcomes for measures of health care use for family physicians who reported some level of burnout, suggesting that the extra attention given to clinical problems and extra communication that may occur during additional time spent by PCPs may be valuable for patient outcomes.”

Primary care physicians are living in a way that most are counseled against. Time and again, we have seen their willingness disregard the phrase about “not setting yourself on fire to keep others warm.” In the US, they’re among the most hard-working of physicians with the best opportunity to intervene in chronic conditions and lifestyle issues, yet they’re at the bottom of the pay scale and often with the least support staff. The failure of policymakers to align payments in a way that will best serve patients and reduce overall costs will continue to haunt us for decades.

Do you have a primary care physician, and can you actually get a timely appointment? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/27/22

October 26, 2022 Headlines No Comments

National Medical Billing Services Announces Acquisition of MedTek

National Medical Billing Services acquires MedTek, which offers RCM software and services to ambulatory surgery centers and other healthcare providers.

Shadowbox closes Series A Funding round with Baleon Capital

Healthcare workflow automation startup Shadowbox raises $6 million in a Series A funding round.

Elion Raises $3.3M in Seed Funding for Digital Health Technology Marketplace

Elion raises $3.3 million to further scale its digital health technology marketplace, which offers buyers evaluations of software and services.

HIStalk Interviews Mike Alkire, CEO, Premier

October 26, 2022 Interviews No Comments

Mike Alkire, MBA is president and CEO of Premier of Charlotte, NC.

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Tell me about yourself and the company.

I’ve been in my role as CEO for the better part of a year and a half. Premier is an evolving business and has been an evolving business in the 18 years I’ve been here. We started as an organization that was focused on supply chain cost reduction and healthcare system quality improvement. We’ve morphed into doing those two elements plus many other capabilities, including standardizing the way that clinicians practice and pharma and med device looking at utilizing our capabilities to help them in real-world evidence studies and in identifying patients for trials.

We created a couple of subsidiary companies in the last few years. They are focused on helping our healthcare systems as they think through new revenue models and are working more closely with the employers in their market. That’s our Contigo Health initiative. We also have an initiative called Remitra, which is all about e-invoicing and e-payables.

Everything we do and contemplate doing is about helping healthcare systems become more efficient, using technology to reduce labor usage and to help them generate more revenue and more profitability.

How can technology make the health system supply chain more efficient?

During COVID, we stood up a coalition of all of the suppliers and distributors of PPE, personal protective equipment. Then we melded that with HHS , FEMA, CDC, and FDA. Because what became painfully apparent in March 2020 was that the federal government didn’t have a real good idea of the location of products to protect caregivers. We quickly stood up that coalition and started getting some traction on getting access to product and getting that supply chain up and running. We understood the utilization patterns of PPE in New York. We used some AI and machine learning capability to forecast from our data as well as the Hopkins data on the progression of COVID. Then we layered our utilization patterns on top our models so that we could help health systems determine the amount of product they needed.

That was important, because everybody was in the market at the exact same time looking for product. That was driving up the cost. Everybody was trying to stockpile against those that actually needed the product. We needed to bring some sanity to that madness. We developed that technology. Some federal agencies are looking at it today as something that they might want to continue to use going forward.

Another element is labor extenders. It’s amazing that 75% of healthcare invoices are still paper. Or focus is to use technology to automate that or digitize those invoices. We have some pretty cool advanced optical character recognition capability and some machine learning capability to make that more effective. But the point is that this invoicing and payment function is still fairly antiquated, and our goal is to bring that up into the 2020s as opposed to being something that has existed for 25 or 30 years.

We are also looking at products and drugs and the outcomes associated with those. We’re so much better at that with our acquisition of Stanson Health. Writing standards of care in Epic, Cerner and Athenahealth that are based on data, how the patient presents themselves, and lab values and other screens is critical. That will evolutionize healthcare. We want to continue to proliferate technology like that all throughout the healthcare system.

You launched Contigo Health three years ago and it recently made a big acquisition of contracts and technology. How is that business doing?

It’s going incredibly well. Thank you for asking. It is meeting its growth profile. Health systems are obviously under a great deal of stress and pain, struggling with high labor costs and supply cost inflation. We are creating new models for them to get access to revenue that maybe they hadn’t had access to in the past. 

Contigo is just one of those ways to do that, to help build plans and capabilities so that health systems can go directly to employers, both in their market and at a national level. That program is doing really, really well. We continue to build the high-value network of health systems that provide care to a significant number of large national and international companies. We bought a third-party administrator a few years back for the centers of excellence programs that most advanced employers or innovative employers use, so that when folks need a knee or a hip done, they can be sent to a national center of excellence. The TPA supports that function.

As you said, we recently ran an acquisition of an organization that has access to a 900,000-provider contract. Our healthcare systems that have health plans can leverage a wrapper that is very economical and has a number of providers who can fill the needs of those health plans outside of the region of where that care is being delivered by that provider. We are excited about the direction that Contigo is going.

Will health system consolidation continue to the point that we have just a dozen or two regional and national health systems?

It’s tough to tell. They are battling against the sheer scale of health plans. Optum and UnitedHealth Group have $500 billion in market cap. You have Anthem, Aetna, and Cigna with market caps of tens or hundreds of billions of dollars. Then you look at the health system, HCA being the largest at $60 billion. It’s a huge issue in access to capital. Do you want our health system being innovated by the providers, or do you want it being innovated by the payers? These health systems are trying to create enough scale to bring a bit more balance against the payers on this.

I don’t necessarily have a prediction in terms of what large health systems will look like. I think you’ll have a lot of regional health systems and then still have local health systems, because those communities have specific needs to the point that they will probably need to remain independent, especially as healthcare continues to move outside the four walls of the hospital.

The way that we will look at health systems in 20 years will be much different than today. We have these big acute settings, non-acute settings, clinics, physician practices, rehab, labs, and all those kinds of things. But health systems are trying to move as much into the community as possible. That means trying to figure out ways to lower overall variable cost and fixed cost. The way that care will be provided in the future is going to be dramatically different, and advanced technology will be needed to help drive that transformation.

Optum is hiring a lot of physicians and buying practices, and at the same time, big retailers could be planning to cherry-pick the most profitable parts of the health system business. How are health systems responding?

When you have well-capitalized companies getting into any space, you’re always going to keep an eye towards that. Our interest, and that of many of our health systems, is to figure out ways to partner with those entities and help them meet the needs of what they’re trying to accomplish. That’s one of the reasons that Contigo got started. It was driven by Walmart trying to figure out ways to get more value for their healthcare dollar. I don’t think this is going to go away. With the rising cost of health insurance, you will see employers continue to look at unique models. We want to be there with capabilities, services, and technology to help them as they transform their healthcare costs.

How is the data connectivity between health systems and life sciences companies changing?

The most important aspect is data security and data protection, making sure of de-identification capabilities and using things like avatars to represent people. Those will be essential in research going forward. That scale will be important. That pharma or med device doesn’t have the ability to reach out to 5,000 hospitals, so scaling all that data and technology is going to be important.

How you consume the data and serve it up will be important in the future as well. Everybody will have different needs in terms of what they’re trying to consume from a data standpoint. You’ve got people in the middle of trials, you’ve got real-world evidence studies, you’ve got off-label utilization of products, you’ve got identification of patients just because of the need for more heterogeneity in these studies and those kinds of things. It depends on the prevailing needs. But the most exciting thing is that technology is coming to a place where we can meet all those challenges just because of a lot of the work that has been done over the last 10 years.

How do you see the business environment playing out over the next two or three years, especially for smaller companies?

It is incredibly important to have strong ROIC, return on invested capital. We want to have nice return for our shareholders and to drive our EBITDA and our cash flow and those kinds of things. Those are the most important parts of a business. When you launch new businesses and you’re making investments in those kinds of things, you have to make sure that you have the right plan in place and that you are getting the right level of returns. Organizations that have great ideas, a strong history of delivering ROIC, and a strong history of delivering performance will generally do well going forward.

The other side of that, as you were talking about it from an investor standpoint, is that it is even more important that we are creating offerings that can show short-term, mid-term, and long-term returns for our customers. It is no longer the day that you’re implementing something that will provide a a return in a year. Health systems are under such duress. You have to be able to walk in with options, services and technology that will help you drive results very quickly. Then, as much as possible, get a lot of that information and insights embedded into the electronic medical record so that you have long-term sustainable improvement as well.

What will be important for the company over the next three or four years?

A couple of things will be critical for us. Even with market’s labor factors being the way they are, this is all about getting great talent into the organization. Recruiting great talent is so interesting. I had a conversation with a student in an MBA program that is top five in the world. I was impressed with her and asked, “Where are you thinking about doing your internship, Google, Apple, or Amazon?” She said, “Yes, I’m considering those because I’m really interested in what they’re doing in healthcare.” I said, “One of the things that we think is unique about Premier is that we truly understand healthcare and have been building incredible technology capability over the years, as opposed to a great technology company that is trying to understand healthcare.” Getting access to great talent is going to be really important.

I constantly challenge my team. Are we continually pragmatically innovating? How are we taking the platforms that we’ve created and creating those next layers of innovation? We’re doing some amazing things using a artificial intelligence, machine learning, and natural language processing.

The sky is the limit for us. Now it’s a matter of getting the right use cases built and getting the right products developed to support our health systems along their journey to transforming the way they are providing care to their patients.

Morning Headlines 10/26/22

October 25, 2022 Headlines No Comments

Telehealth unicorn Cerebral lays off 20% of staff for ‘operational efficiencies’

Virtual mental health provider Cerebral lays off 20% of its staff, reportedly affecting 400 employees in primarily clinical and care counselor roles.

Electronic Caregiver Announces the closing of an additional $42.5 Million in Funding to Accelerate Expansion

Electronic Caregiver, which offers remote patient monitoring, virtual care, and chronic care management services, raises $42.5 million.

Hospital for Special Surgery (HSS), The Global Leader in Orthopedics, Launches Newco Targeting $380B National Musculoskeletal Health Burden

Hospital for Special Surgery announces plans to launch for-profit virtual musculoskeletal physical therapy provider RightMove, which is backed by a $21 million Series A funding round.

VA Awards Oracle Cerner $956M in EHR Modernization Task Orders

The VA awards Oracle Cerner $956 million worth of task orders to continue its rollout.

News 10/26/22

October 25, 2022 News 2 Comments

Top News

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Philips reports lower revenue and a loss of $1.28 billion in Q3 due to supply chain issues and the recall of several million of its CPAP devices.

Newly appointed CEO Roy Jakobs says the company will immediately lay off 4,000 employees.

Philips hopes that remediation of 4 million CPAP and ventilator devices – which were found to contain foam whose degradation can cause serious injury or death — will be completed for 90% of users by the end of the year.


HIStalk Announcements and Requests

Lorre and Jenn are looking for fun ways to celebrate HIStalk’s 20th birthday in June 2023, should you have ideas.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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HealthStream announces Q3 results: revenue up 5%, EPS $0.12 versus $0.05. HSTM shares are down 23% in the past 12 months versus the Nasdaq’s 27% loss, valuing the company at $666 million.

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Point-of-care digital patient education company CheckedUp acquires competitor Health Media Network.

Virtual mental health provider Cerebral lays off 20% of its staff, reportedly affecting 400 employees in primarily clinical and care counselor roles. A round of layoffs earlier this year impacted support and operations teams. The news comes less than a month after fairly new CEO David Mou, MD renewed the online mental healthcare company’s commitments to clinical safeguards and patient identification verification protocols and software, areas in which it has come under federal and consumer scrutiny. He also vowed to conduct a comprehensive review of internal operations and performance.


Sales

  • Arizona HIE Contexture selects technology from Unite Us to power its CommunityCares social determinants of health referral system.
  • OSF Healthcare (IL) will use CareSignal’s deviceless remote patient monitoring technology as part of its OnCall Connect digital care management service.
  • Sinai Medical Group (IL) will implement physician RCM services from Conifer Health Solutions.

People

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Walmart Health hires Claude Pirtle, MD, MS, MBA (West Tennessee Healthcare) as CMIO.

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Brian Graves (RelayOne) joins Resolv Healthcare as VP of sales and marketing.

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CVS Health hires Amar Desai, MD, MPH (Optum) as president of its newly formed healthcare delivery organization.

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Commure hires Chris Kuhns, MBA (Iris Telehealth) as CFO.

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Jamie Hall (Transcarent) joins virtual primary care vendor CirrusMD as president and CEO.

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Health Recovery Solutions names Jaydeo Kinikar, MBA (Best Buy Health) chief product officer.

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Laizer Kornwasser, MBA (CareCentrix) joins Teladoc Health as president of enterprise growth and global markets.

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RevenueWell promotes Julie Coviello to chief customer officer.

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Medical device data platform vendor Canary Medical hires Lisa Suennen (Manatt, Phelps & Phillips, LLP) as president of digital and data solutions.

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Mark Burgess (NextGen Healthcare) joins Agfa HealthCare as president, North America.

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Health Care District of Palm Beach County hires Daniel Scott (Good Samaritan) as AVP/CIO.

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Denis Tanguay, MSHA (Huntzinger) joins Sturdy Memorial Hospital as VP/CIO.

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Tim Johnson (247/ai) joins Nuance Communications as head of UK sales, healthcare.

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Talon hires Elif Eracar, MS (Redox) as COO.

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Atlas Health hires David Franklin (Ontario Systems) as president; Christopher Parks (Avaneer Health) as chief client officer; Nicole Nye, MBA (Finvi) as VP of product management; Nicole Hess, MBA (Olive) as SVP of marketing; and Todd Helmink (PatientBond) as head of strategic partnerships.


Announcements and Implementations

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Penn State Health’s Milton S. Hershey Medical Center goes live on Oracle Cerner.

ACO MultiCare Connected Care implements prior authorization automation technology developed with MCG Health using the HL7 Da Vinci Project FHIR standard.

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Lake Region Healthcare (MN) will go live on Epic November 1 through a Community Connect partnership with Sanford Health.

Healthcare concierge program Renee adds a flat-fee prescription drug program that covers 500 commonly prescribed generic medications for $25 per month. The company was founded by the husband-and-wife team of Nick Desai, MS and Renee Dua, MD, who founded doctor house call company Heal in 2014.

Hospital for Special Surgery announces plans to launch for-profit virtual musculoskeletal physical therapy provider RightMove, which is backed by a $21 million Series A funding round.

A Harvard study of an academic medical center’s orthopedic surgery patients finds that patient-reported outcomes are completed less often by patients who are black, covered by Medicare, aren’t married, don’t speak English, or who haven’t activated their patient portal account, which could create bias in clinical outcomes research. The authors speculate that patients who activate a portal account are self-selected for technology fluency, access to technology, and willingness to engage and manage their health.

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CHIME’s Fall Forum will be held November 7-10 in San Antonio. The opening keynote speaker is humanoid celebrity Sophia, while the closing keynote will be offered by the US Navy’s first F-14 Tomcat fighter pilot Carey Lohrenz.


Government and Politics

The VA awards Oracle Cerner $956 million worth of task orders to continue its rollout.

North Carolina’s state treasurer says that the non-profit “hospital cartel” always puts profits ahead of patients in providing vague and sometimes conflicting data about the benefit they provide taxpayers in return for billions of dollars worth of tax exemptions. The report cites Atrium Health, which claimed that it lost $640 million in Medicare patients, but whose financial reports show a $120 million profit on those patients. National analysis shows that nearly all health systems spend less on charity care than they receive in tax breaks.


Privacy and Security

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The US Cybersecurity & Infrastructure Security Agency advises the healthcare and public health sector of ransomware attacks and data extortion schemes conducted by the Daixin Team. The group has been especially active over the last five months, with Oakbend Medical Center being one of its more high-profile victims. It stole 3.5 GB of data from the center in September, after which it published a sample of 2,000 OMC patient records on its data leak site.


Other

A fascinating article describes how, in the late 1960s, two pathology residents at Englewood Hospital (NJ) used their hands-on experience with newly developed lab test processing machines to later form what became Quest Diagnostics and LabCorp. The companies used that automation to scale, reducing per-test cost and weeks-long  turnaround times to the point that smaller labs either went out of business or sold out to the companies. One expert says that they are no longer lab companies, but rather “M&A companies in the lab space.” Competitors can’t crack the exclusive contracts that insurers sign with Quest and LabCorp and can’t compete with their armies of salespeople, so their only options are to focus on a low-profit niche like allergy testing, locate in low-density population areas that are unattractive to the big players, or agree to be purchased. The article goes off track a few paragraphs in, ranting off topic on electronic medical records except pointing out that EHRs don’t make it easy for doctors to choose competing labs.


Sponsor Updates

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  • Clearsense sponsors Banner Health’s Pulse of the City Soiree.
  • Kyruus publishes its sixth annual patient access journey report, “The Many Digital Doors of Patient Access and Engagement.”
  • The Who Would Have Thought: Digital Health Innovation Podcast features Arrive Health CEO Kyle Kiser.
  • Azara Healthcare achieves HITRUST risk-based, two-year certification.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Implementing an effective hospital-at-home care delivery model.”
  • Bamboo Health affixes new signage to the top of its office building.
  • Clearwater announces that the National Association of Corporate Directors has recognized founder and Executive Chairman Bob Chaput as NACD Directorship Certified.
  • Diameter Health will exhibit at the NCQA Health Innovation Summit October 31-November 3 in Washington, DC.
  • EClinicalWorks publishes a new customer success story showcasing how its AI-based Scribe dictation technology has helped Open Door Family Medical Center combat pandemic challenges and reduce physician burnout.

Blog Posts


Contacts

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

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Morning Headlines 10/25/22

October 24, 2022 Headlines No Comments

Healthcare tech giant Philips scraps 4,000 staff worldwide

Philips will lay off 5% of its global workforce in an effort to bounce back from its $1.28 billion Q3 loss, brought on in part by the recall of its potentially defective sleep apnea machines.

CISA Warns of Daixin Team Hackers Targeting Health Organizations With Ransomware

The US Cybersecurity & Infrastructure Security Agency advises the healthcare and public health sector of ransomware attacks and data extortion schemes conducted by the Daixin Team.

Unified Women’s Healthcare acquires Gennev to become the leader in menopause care in the US

Practice management company Unified Women’s Healthcare will acquire Gennev, a digital care company for menopausal women.

Curbside Consult with Dr. Jayne 10/24/22

October 24, 2022 Dr. Jayne 4 Comments

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I’ve used a GPS watch to track my hikes and other travels for almost a decade. Recently, some of the features on my trusty Garmin Forerunner 25 have become erratic and had me looking for an upgrade. I’ve had it for seven years and it has served me well, but I was annoyed after the GPS went rogue a couple of times and the sleep tracker started showing the same pattern whether the watch was on my wrist or on the bathroom counter.

After extensive troubleshooting with Garmin, they couldn’t come up with a remedy and offered me a discount, but only if I stayed within the Forerunner line. I wasn’t thrilled with the options and had been casually looking at other models when a friend clued me in to a sale, spurring me to make a decision.

Wearables hold an interesting place in the hearts and minds of patients. I have plenty of friends that are obsessed with “closing the ring” on their Apple watches to the point where they are almost a servant to the technology. I’ve taken care of patients who take their daily activity tracking data seriously, to the point of messaging their physicians asking about what the slightest blip in their numbers might mean.

I’m not training for half marathons anymore, so I don’t need a lot of the training or coaching features that are out there. I wanted something with decent battery life, both as a watch and in GPS mode, as well as something that looks a little more stylish and a lot less rubbery than my current device. I settled on a watch from the Garmin Venu line.

Garmin’s packaging has become more streamlined since my last purchase. However, the setup process was considerably more complicated. Although I already had the Garmin Connect app on my phone, I couldn’t get it to pair with the watch and had to update the app. It still didn’t work, so I thought I would set up the watch manually then try the Bluetooth piece later.

Garmin is apparently confused about sex versus gender and how biological sex is more aligned with physiologic parameters than gender and only gave a choice of two genders. I picked the stereotypical pink icon with the ponytail, but hope someone at Garmin gets educated about the difference between sex and gender.

The next step was trying to set the watch via the GPS, which didn’t work. I’m assuming the GPS wasn’t working well inside my house, but since you’re supposed to have the device plugged in with the USB cable and charging while you do this, I was just following the directions. I’m not sure how many people have USB ports in their driveways.

I also ran across the menstrual tracking option on the device, which I promptly turned off. Most people don’t realize that HIPAA does not protect this kind of data when it’s being sent to an organization that is not a HIPAA-covered entity, and especially given the political climate, I have no plans to share that via a wearable.

During this process, the watch fell on the floor no less than three times due to the short USB cord that was connected to my floor-dwelling PC, coupled with the fact that it hooks perpendicularly into the back of the watch, making it unable to be placed flat on a surface.

The next step was to apply a system update to my phone, which for some reason took several hours. I tried several more times to get it to connect without any luck. Ultimately, I used Garmin Express to connect it directly to the PC, after which it forced a firmware upgrade to the watch. I was hopeful that would do the trick, but it didn’t. However, while the watch was connected to the PC, I was able to connect it to my wifi network, so at least that was something.

After disconnecting the watch, I had to take care of some household tasks and noticed that the watch wasn’t counting steps. It was counting heart rate and respirations, which I find less useful, and not doing the one task that was most important to me. After lots of fussing about with the menus, I tried a system setting to see what version the firmware was on, and it said that an update was needed. I tried to connect it back to the PC, but it wouldn’t pick up, and after plugging it in and unplugging it way too many times, it finally connected and the Garmin Express software showed that despite the recent status of “update complete,” three more updates were now needed.

Each time an update completed, I had to do a manual sync to get the next update to register, and also restart the watch. Meanwhile, Garmin Express kept telling me that the watch wasn’t connected, while the watch showed that it was.

I was asked no less than three times during the process to set up wifi and went through the entire process to have no change in the user experience. I went back to the main Garmin Express menu and was now told that I had 37 updates available even though the previous screen had said, “You’re up to date!” There is nothing worse than a confusing user interface that doesn’t tell you what’s going on or what you really need to do.

After two more unplug-and-restart cycles, the update counter disappeared and and miraculously, over 4,000 steps appeared on my watch. There’s no way they’re legitimate considering I was only wearing the watch for a couple of trips to the laundry room and back. After some digging, I figured out that somehow the steps on my old watch had been ported onto the new watch, which was definitely unexpected.

Fast forward to nearly a week worth of intermittent attempts to connect via Bluetooth. I gave up on it. I can pair the watch to someone else’s phone and pair my phone to other devices, but can’t pair the watch to my own phone. Without the Bluetooth, you lose out on several valuable features – music, alert notification for falls or incidents, and a couple of other things. I’m still able to sync the watch with my PC like I was the previous model. I hadn’t planned to allow it to display text messages or emails, so I resigned myself to being a little retro with my connectivity. I’m hypothesizing that the battery life will be much better without the connection, but I’ll know for sure in a few more days.

It’s snazzier than my previous device. I like its subtle coloring and low profile versus the chunky black model I’ve been wearing for years. For the first couple of days, the synthetic material watch band had a particular smell to it, which probably wouldn’t mean much to the average person, but to me smelled like an operating room. Although it brought back some fond memories, I was glad when it dissipated.

Overall, I’ll give this particular Garmin a solid B. It’s better than my last one, but not as great as it could be. The price was right.

What’s your favorite wearable, and how do you like (or dislike) its features? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Applying AI to Improve Patient Care

October 24, 2022 Readers Write 3 Comments

Applying AI to Improve Patient Care
By Tomas Gogar

Tomas Gogar, MS is co-founder and CEO of Rossum of London, England.

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Despite the technological advancements in healthcare over the past decade, the administration and quality of patient care has not kept pace. The industry is faced with the realization that if technological changes aren’t implemented at a foundational level, providers, payers, and patients won’t be able to realize the full value of the technology available to them.

The majority of medical institutions rely on electronic health records (EHR) to input, read, and upload critical documents related to patient care into online portals. The EHR concept, introduced in the 1960s, while valuable to the healthcare community, has yet to eliminate the need for manual paperwork. Paperwork is a huge drain and cost, taking time, energy, and precise attention to detail to ensure that all documents are properly scanned into the correct patient files.

Missing information can lead to delays in care, misdiagnosis, miscommunication around treatment plans, and the duplication of costly tests and procedures. Relying strictly on manual processes to manage such large amounts of information can be administratively crippling to a healthcare organization. The World Health Organization estimates that up to 50% of all medical documentation mistakes result from administrative errors.

By integrating intelligent document processing (IDP) into the systems, hospitals and healthcare institutions save time, reduce operational costs, and improve workflows. Introducing an IDP system into the EHR workflow means medical professionals across departments can easily scan and upload documentation into a secure SOC 2 and HIPAA compliant operating system. IDP efficiently captures, categorizes, extracts, and classifies data from documents, streamlining the workflow process and reducing the paperwork necessary for a patient file.

IDP also helps sustain HIPAA compliance, which can be challenging when dealing with thousands of physical documents stored in different formats and locations across a health system. Accounting for small margins for human error causes long input times and exhaustive efforts to safeguard physical documents containing patient information. With the implementation of IDP, this process eliminates any chance of human error in handling sensitive information and allows for patient data to be processed quickly, safely, and securely.

From a patient perspective, automating and streamlining document processing enables providers to get complete, accurate data straight into a patient’s hands via online portals. From the healthcare organization side, IDP can reduce document burnout that healthcare professionals are prone to experiencing.

For hospitals struggling with overhead operational costs, implementing IDP is a lucrative resource. By using IDP to process documents like prescription referrals, lab records, billing, and claims forms, manual data entry is drastically reduced, thereby reducing the need for resources associated with data entry into EHR and patient portals and enabling the healthcare organization to re-allocate them to more strategic tasks. In addition to labor costs, implementing IDP reduces costs associated with paper storage, security measures in place to store these documents, and any costs associated with administrative errors.

During a time when all our hospitals are critically understaffed and underfunded, ensuring that every worker is given the necessary tools and resources to adequately and efficiently perform their jobs is more crucial than ever.

Readers Write: Thinking Differently About OR Block Time

October 24, 2022 Readers Write 2 Comments

Thinking Differently About OR Block Time
By Michael Burke

Michael Burke, MBA is founder and CEO of Copient Health of Atlanta, GA.

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The operating room is the hospital’s largest source of earnings, as well as the largest hospital cost category. Most OR time is allocated in advance to surgeons in chunks of time called blocks. Surgeons schedule cases into their allocated block time, such as Tuesdays from 7 a.m. to 3 p.m.

Block time often goes unfilled due to poor allocation decisions, case volume that can vary meaningfully from week to week, and surgeons neglecting to release block time when traveling or otherwise unavailable to use it. Often, OR time that sits empty can be filled with elective cases that have an average contribution margin of $2,000 per OR hour. Instead, the fixed costs from unused OR hours add up with no revenue to offset them.

Identifying block time that would otherwise go unfilled, getting it released, then refilling the time is something hospitals have attempted to do for quite a while. The process has been largely manual and has missed a meaningful portion of the opportunity, as evidenced by block utilization statistics.

New tools use machine learning to predict block time that is likely to go unfilled, along with mechanisms for seeking the release of the identified time and requesting the time. Finding more time, getting it released earlier, and getting it into the hands of those who can use it are all excellent reasons for adopting such a solution. Hospitals can make real gains with this approach. The core of the strategy is that any block time that would otherwise go unfilled should be filled with positive contribution margin cases whenever possible.

Surgeons are hesitant to release block time allocated to them, even if they don’t have cases to fill it. In most compensation scenarios, a surgeon has a financial incentive to hold on to any OR time allocated to them in the event that a case might come along later. Even if they are an equity holder in an ASC and benefit from facility earnings shared as dividends, they are still subject to a form of the prisoner’s dilemma. This affects their decision-making and can bias them against releasing allocated block time for which they don’t have cases to fill. Although some portion of unused time is collected from surgeons by proactive nudge reminders and the ad hoc efforts of the scheduling team, diverging incentives unnecessarily limit the amount of time that can be recaptured and repurposed.

In many ways, the math behind the predictions is the easy part. The difficulty lies in aligning incentives and driving changes in behavior. The structure of your incentives and your willingness to push will have as much or more impact on the success of an OR optimization effort as the predictive software you select. Maybe we should also consider taking lessons from other industries dealing with similar scarce resource challenges.

What if we thought of a hospital as an airline and an OR block day as a flight? Travelers or travel agents (schedulers) book seats on the plane (cases in the OR). However, from its predictive analytics, the airline knows that some seats will go unfilled, even if booked to capacity. The OR block appears to be booked to capacity in much the same way  since 100% of the block’s time is allocated to the block holder.

But we know the block holder won’t fill all the allocated time, just like the airline knows that without intervention, many more seats on the plane would go empty due to no-shows or missed connections. The airline uses predictive analytics to intentionally and confidently overbook the flight to account for this.

The hospital should consider a similar process because the block holder often won’t fill an entire block with cases. To be clear, you wouldn’t be overbooking, since the chunks of time into which you would book cases are empty and predicted to remain so. The math behind the predictions for an OR is different from that of an airline flight, but the analogy still applies. By adopting this strategy, hospitals could fill much more time in their OR blocks with a high degree of certainty that the block holder won’t need it. This approach bypasses the behavioral challenge of seeking permission from the block holder early enough for the unneeded time to be usable, resulting in more recaptured OR time and more contribution margin.

Morning Headlines 10/24/22

October 23, 2022 Headlines No Comments

Lawsuit accuses medical tech company Masimo of creating an Apple Watch clone

Apple sues medical technology company Masimo, claiming that it cloned the Apple Watch for its W1 Advanced Health Tracking Watch.

Oracle CloudWorld 2022: Ellison Says An ‘Internet Of Clouds’ Is Imperative

Oracle co-founder and CTO Larry Ellison tells CloudWorld 2022 attendees that the company will partner with other companies to build next-generation healthcare applications, saying that “there’s no way we can do this by ourselves.”

Antidote axes a third of its employees

Antidote Health, an Israeli company that markets its telemedicine service to consumers in the US, will reportedly lay off 23 local employees.

Henry Ford Health’s Specialty Pharmacy Software Goes National

Henry Ford Health commercializes its internally developed DromosPTM patient therapy management solution for specialty pharmacies.

Monday Morning Update 10/24/22

October 23, 2022 News 4 Comments

Top News

Oracle co-founder and CTO Larry Ellison tells CloudWorld 2022 attendees that the company will partner with other companies to build next-generation healthcare applications, saying that “there’s no way we can do this by ourselves.”

Ellison again touted creation of a national health records database, warning that healthcare costs will bankrupt Western civilization unless efficiency is improved,

He added that acquiring Cerner was “maybe the single most important thing we did in terms of expanding our own capacity.”  


Reader Comments

From Jostler: “Re: tokenization. Any experts out there you could interview, or any summaries of how it is actually being used? I can’t tell if it’s hype or if it will be useful to get more data.” Tokenization is a way to link several data sets together so that a patient can be viewed as an individual via an encrypted token. The underlying data remains de-identified. A researcher would be able to tell that a given oncology clinic patient also picked up prescriptions at Walgreens and visited two health system EDs, for example, but would not be privy to that patient’s private information. I would be interested in hearing from people who have tokenization expertise or who have used it for research.


HIStalk Announcements and Requests

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Poll respondents who could move anywhere would most often consider the new area’s proximity to family, weather, and social and political environment. Interesting, few respondents care much about access to high quality health services, perhaps not yet having attained the age in which quality and quantity of life might depend on the services available in your location’s medical golden hour. Some respondents say that proximity to an airport that is an airline’s major hub would have ranked high on their list.

New poll to your right or here, extending Dr. Jayne’s experience where the front desk person insisted she didn’t owe the co-pay that was clearly listed on her insurance card. In your most recent ambulatory medical encounter in which you owed a co-pay, was it collected before you left?


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


People

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Jamey Pennington (Coker Group) joins Southwell as VP and chief information and HIPAA security officer.

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CoverMyMeds promotes Lindsay Miller to VP of account operations.


Announcements and Implementations

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Henry Ford Health commercializes its internally developed DromosPTM patient therapy management solution for specialty pharmacies.


Government and Politics

A Florida man pleads guilty to conspiracy and kickback charges for running an Internet-based platform on which physician orders for back and knee braces were bought and sold, yielding him a cut of the transactions. Nagainda Srivastav also ran call centers to find beneficiaries who could be billed for DME, then bought physician orders from offshore telemedicine companies that he sold online. His scheme generated at least $25 million in federal healthcare payments. His B2B Apps Solutions sells cloud-based pharmacy and EHR apps. Basic Googling turns up his $2.4 million, 8,900-square-foot  waterfront home in Tampa.

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Apple sues medical technology company Masimo, claiming that it cloned the Apple Watch for its W1 Advanced Health Tracking Watch. Masimo previously accused Apple of contacting it in 2013 about potential collaboration, then using the meeting to identify Masimo employees it could poach, including its chief medical officer and those knowledgeable about pulse oximetry sensors, which Masimo says it invented.


Privacy and Security

Sen. Mark Warner (D-VA) sends a letter to Meta CEO Mark Zuckerberg, asking him to explain how its Meta Pixel tracker collects, stores, and uses the information of website visitors. He also wants to know what steps have been taken since The Markup publicized Meta Pixel’s use by health systems and how the system filters sensitive health information.


Other

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A New York Times article on preparing for surgery suggests using Abridge, an app that records doctor-patient conversations and shares the recording and transcription with both. Co-founder and CEO Shiv Rao is a UMPC cardiologist and spent time as EVP of UPMC Enterprises.

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The San Diego sheriff’s department will monitor its most medically vulnerable incarcerees using tamper-proof biosensor trackers, hoping to reduce in-custody deaths. The $1,000 ankle-attached trackers will be provided by 4Sight Labs, which a Colorado police department credits with saving the lives of three people who were in custody.


Sponsor Updates

  • OptimizeRx and Melinta Therapeutics will present Innovate4Outcomes, a virtual event that will focus on antimicrobial resistance,  on December 1.
  • Sphere will exhibit at Athenahealth’s Thrive conference October 24-26 in Austin, TX.
  • Volpara Health achieves B Corp. Certification.
  • Wolters Kluwer Health publishes a new e-book, “Transforming the Nursing Workforce: Keys to Delivering Health Equity and Fostering Resilience.”
  • Verato will exhibit at APHSA ISM 2022 October 23-26 in National Harbor, MD.

Blog Posts


Contacts

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

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Morning Headlines 10/21/22

October 20, 2022 Headlines No Comments

Health system data breach due to Meta Pixel hits 3 million patients

Advocate Aurora Health joins other large health systems in notifying millions of patients that their information was potentially exposed via the Meta Pixel website user tracker.

CitiusTech Announces Investment and Strategic Partnership from Bain Capital Private Equity

Digital health technology and consulting company CitiusTech secures an undisclosed amount of funding from Bain Capital.

Connective Health Announces the Completion of its Seed Funding Round

Connective Health, a Boston-based clinical summary and predictive insights startup, wraps up its seed funding round with financing led by Activate Venture Partners.

News 10/21/22

October 20, 2022 News 5 Comments

Top News

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Advocate Aurora Health joins other large health systems in notifying millions of patients that their information was potentially exposed via the Meta Pixel website user tracker.

AAH says it is notifying all of its 3 million patients that it had installed the tracker on its MyChart and LiveWell patient portals, which gave Facebook advertisers access to their IP address, appointment details, providers, type of appointment, MyChart messages, and insurance information.

AAH says it installed the pixel to evaluate how consumers use its websites, but was not aware of the extent of information that was being collected and sent to third parties. It has removed the tracking tool.


Reader Comments

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From Garbanzo: “Re: Unite Us. They may be the SDOH platform giant in terms of business, but not in KLAS reports.” Click to enlarge the graphic above that was sent by this reader, which compares competitors Findhelp and Unite Us in the categories of culture, loyalty, operations, product, relationship, and value.

From Isthmus: “Re: NH SB 423. The privacy bill was actually supported by Unite Us, voting was unanimous, and the Unite Us contract was placed in moratorium and then ended because it didn’t meet state privacy rules. Testimony is here.”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Here’s the recording of this week’s webinar, sponsored by Mend, titled “Patient Payment Trends 2022 Learn All The Secrets.”


Announcements and Implementations

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Trilliant Health’s excellent annual health economy report makes these points (I interviewed SVP / Chief Research Officer Sanjula Jain, PhD a few months ago):

  • The number of commercially insured Americans, who drive most of healthcare’s profits, is declining, and the Medicare-eligible population is growing faster than other cohorts.
  • Cancer screening volume is down, making it likely that initial diagnoses will be made in more advanced stages.
  • Behavioral health and related medication prescribing are up significantly, but vary by market.
  • Hospital inpatient and outpatient volumes have been flat for years even as obesity and chronic disease increases. Digestive surgeries will have the highest growth in almost all markets.
  • Telehealth utilization remains high, but is being used significantly less that at its peak by seniors and children and is broadly shifting back to mostly in-person care. Most patients who have used telehealth have done so only once, and the biggest use is for behavioral health. Oversupply will cause telehealth visit prices to keep dropping, possibly to $0 if commercial insurers offer them at no cost.
  • Medicare and Medicaid spending and projected increases are unsustainable and Americans have accumulated $140 billion in medical debt.
  • Services are rapidly shifting to ambulatory settings. 
  • The report observes that “only in healthcare can a monopoly lose money” as even market-controlling hospitals generate negative margins. It also notes that “the paradox of declining demand and rising price defies the laws of economics” as US healthcare prices keep rising as outcomes such as life expectancy keep falling. 

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A study finds that use of AI-powered wound imaging and analysis software from Net Health allowed a virtual wound care program to provide quicker access and improved management to remote patients who took photos of their own wounds for specialist review.

LexisNexis Risk Solutions launches MarketView Patient Journey Intelligence, which uses tokenization technology to link de-identified datasets to analyze a patient’s movement through the care continuum.

An AHIMA white paper urges health information professionals to take on roles related to analytics, managing social determinants of health, helping clinicians use EHR information to engage patients, working with the design and management of online tools for value-based care, supporting efforts to roll out digital front doors, and developing AI processes. Interviewees differed on whether health information professionals will work more directly with patients.

Meditech launches Expanse Population Insight, which uses claims and EHR data from the Innovaccer Data Platform to provide information about risk, care gaps, and utilization at the point of care.

The joint venture health plan owned by Banner Health and Aetna/CVS Health rolls out “frictionless billing,” which shows patients what the provider billed, what insurance covered, and what they personally owe so they can pay their balance.


Government and Politics

FDA warns that amphetamine-based ADHD drug Adderall is in short supply. Experts question whether the shortage may have been exacerbated by online startups that marketed their prescribing of the drug via virtual virtual encounters that were convenient, inexpensive, and sometimes short on sound medical practice.


Privacy and Security

Analysis by data privacy firm Lokker finds that of 5,000 websites of hospitals and healthcare services providers, 40% use trackers from Facebook, 13% from Microsoft, 8% from Twitter, 6% from Pinterest, and 5% of TikTok. The company says that the web browser is the new endpoint to defend, containing privacy risks such as malware, PHI data skimming, and data broker fingerprinting scripts that repeatedly enrich user profiles to the point they can identify a specific website visitor.

A hacker breaches Australia’s insurer, Medibank, and steals 200 gigabytes of data that includes customer medical procedures, diagnoses, addresses, and credit card details.  A hacker group told the company it was interested in negotiating the disposition of the information it took.


Other

The Atlantic says that COVID-19 datasets are no longer reliable for predictive purposes due to (a) uncounted home test results; (b) CDC and stage agencies moving to weekly instead of daily reporting; and (c) and some states ending their reporting entirely. It says that hospital-reported data is sound, but it lags cases and doesn’t necessarily reflect transmission rates. Wastewater surveillance is consistent and free of biases for trend analysis. The authors also recommend conducting local population surveys to understand how many people are testing positive and what demographic groups they are in.

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A medical building’s janitor is charged with felony aggravated assault with a deadly weapon when a co-worker’s hidden camera captures him urinating into the water bottle she had left on her desk. The woman, who was trying to figure out why her water always tasted and looked funny, says that she caught herpes from the contact. Eleven of her co-workers have come forward with similar complaints. The janitor admitted to police that he had repeatedly peed into employee water bottles and the building’s five-gallon dispenser and admits to doing the same thing at other buildings where he was assigned by his janitorial services employer.

A woman who visited the ED of John Muir Medical Center fearing fentanyl poisoning sues the health system for for billing her $6,100 for a drug screening test for which it accepts a $62 payment from Medicare. The woman says the ED wouldn’t see her until she signed a contract that required her to pay “regular rates and terms” and didn’t run the urine screen until after her three-hour visit, for which the health system wants her to pay $7,100 on top of the $6,000 that insurance has already paid.


Sponsor Updates

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  • Netsmart sponsors MHMR Tarrant’s 15th Annual Opening Doors Dinner to raise money for specialized therapies, transitional living, and peer support programs in the Fort Worth, TX area.
  • Healthcare Triangle publishes a new whitepaper, “Moving Your Healthcare Digital Strategy from Theory to Execution: CHIME’22 Survey Reveals 3 Insights.”
  • Nordic Consulting is recognized with best employer awards from Comparably and Madison Magazine.
  • Healthcare Growth Partners advises Council Capital and Health Enterprise Partners in their platform investment in Alivia Analytics.
  • Clearsense posts a new infographic titled “The ROI of Legacy Data.”
  • Impact Advisors will sponsor and present at the 2022 Analytics + CIO: Real-World AI Transforming Healthcare Now Summit November 17-18 in Scottsdale, AZ.
  • Intelligent Medical Objects will exhibit at NextGen UGM November 6-9 in Nashville.
  • Intrado and Loyal will exhibit at Athenahealth’s Thrive Summit October 24-26 in Austin, TX.
  • Konza National Network names Claude Brunson, MD to its Board of Directors.
  • Lyniate will host its Connect conference October 24-28 in Frisco, TX.
  • Meditech releases a new podcast, “Reimagining the future of healthcare.”

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.

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EPtalk by Dr. Jayne 10/20/22

October 20, 2022 Dr. Jayne 1 Comment

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I went to look at the pricing and deadlines for the HIMSS23 conference earlier this week and it looks like they’re doing a little bit of a cash grab in switching up their pricing. It used to be that the basic conference pass, at the lowest price point, included access to the session records. Now you’ll have to pay an upcharge of nearly $300 for that privilege.

In addition to the recordings, the middle price point also includes access to the pre-conference forum as well as admission to the Thursday night special event. The highest price point adds on attendance at the CXO experience and the Executive Summit / Reception. I haven’t done my registration yet, so I can’t see whether there are a la carte offerings for the different items as well, but hopefully I’ll get around to that soon.

Within the last couple of years, I worked for a couple of telehealth companies. Over the weekend, one of them began texting me about surges in patient volume, despite the fact that I haven’t worked for them in months. For a while I was wondering what kind of activity happened on their system that my phone number has come back from the dead, and then it occurred to me that maybe they’ve just had a slow summer and they’re starting to see an uptick in patient requests due to the increase in cases of influenza and other viral illnesses. Regardless of the reason, texting STOP made them requests go away, which dramatically increased my provider satisfaction.

Speaking of satisfaction measures, I recently received a survey from a vendor who knows I’m extremely dissatisfied with their service. I tried to dodge it by ignoring it, but I kept being peppered by requests that appeared to be from the individual service rep, who is well aware of my dissatisfaction. I know about statistical sampling and the need to have an adequate number of responses, but it boggles my mind that they would continue to beat down the door of a disgruntled customer to the point where I felt like providing an even more negative response than I had intended to deliver. I slept on it for a couple of days then finally sent it over, trying to be as fair as possible. I hope I’m tagged in their customer relationship management as being in remediation, and that based on my very pointed feedback, that they reconsider how they’re sampling customers for routine surveys.

One of my friends reached out to ask my opinion on a medical billing situation. Apparently his insurance only covers vaccines when they’re administered in a physician’s office as opposed to covering them when they’re given at a retail clinic. At least in my community, pricing at Walgreens, Target, and CVS are all cheaper than a vaccine at a physician office and are often more convenient for the patient. I tried calling for a flu vaccine for a family member at their own primary care provider’s office, and after several weeks of trying to get through and continuing to be placed in voice mail purgatory, I gave up and took him to Costco for a quick and convenient vaccine. Fortunately it was covered by his insurance, but it just goes to show how off-kilter our current healthcare delivery system is.

Quote of the week: I loved this quote on the recent Monday Morning Update: “It’s a good lesson for vendors who think AI/ML is the universal hammer for all healthcare nails – Epic has 40-plus years of experience working with the best health systems in the country, so if it can mess up a clinical algorithm, imagine the clinical damage your cool startup and its team of former beer-ponging Facebook engineers could do.” I’ve worked on several AI and ML projects in a variety of settings, including academics, startups, and with startups that were spun off from academic medical centers. I’ve found that doing AI/ML the right way is almost universally harder than people think it is, especially if you want to ensure that you’re training your models in a way that avoids bias and works for diverse populations. If you’re like some of my former colleagues who jumped from retail IT to the clinical space and thought they knew it all, I hope you’re employing experienced clinical informaticists to save you from yourself.

This week included some adventures in healthcare, with weirdness on both the clinical and revenue cycle fronts. I had an annual visit with one of my subspecialists, who uses a scribe. Usually I find that it makes the visit more efficient, and this visit was no exception. Since we’re in the era of unbridled data sharing, I couldn’t wait to see what my visit note looked like. At this clinical office, they never take my co-pay and I always wind up receiving a bill, so I tried to pay the co-pay at checkout. They told me I didn’t have one, and I insisted that I did and offered to show them my card that said so. The clerk said she would check in the system and figure it out, then came back with a “definitely no co-pay” verdict. I asked her to check the practice management system, where she’d clearly see my annual visits and the subsequent copay being billed and my payments, but she refused. This is the only office I’ve been to that refuses cash at the time of service, so I’m not sure what era their billing team is living in.

The weirdness continued when I returned home and looked at my visit note, which was already available. Imagine my surprise when I saw the documentation that the patient had completed a questionnaire, including a comprehensive review of systems, and that I had discussed it with the physician, since neither of those events occurred. The templated documentation also noted that the document was scanned, which is interesting because I’ve never completed anything like that at this office. This is the second time this year I’ve been confronted with erroneous visit notes and I’m still wondering what the best way is to handle them. In this case, it doesn’t impact the outcome of the visit or my future care, so I’m not that excited about bringing it up. In the other case, there were material errors in the chart, but I still don’t know the best way to deal with them. I’ve decided to leave that provider’s care anyway, and the errors aren’t anything that are going to impact future care or payments or anything else, but they’re just annoying.

Have you had errors in your visit documentation after seeing a healthcare provider? How did you handle the situation? Leave a comment or email me.

Email Dr. Jayne.

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