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EPtalk by Dr. Jayne 3/2/23

March 2, 2023 Dr. Jayne 3 Comments

The hot topic around the virtual water cooler this week was the National Labor Relations Board (NLRB) decision this week that employers can no longer use two specific strategies to silence laid-off employees. Employers are not permitted to include overly-broad confidentiality clauses as terms of a severance agreement. Additionally, they are not permitted to include broadly written non-disparagement clauses that prohibit discussion of previous employment with third parties.

The case involved hospital employees in Michigan who were furloughed when non-essential services were halted during the early days of the COVID-19 pandemic. The decision applies to all US employers with the exception of railroads and airlines. There’s always the chance of an appeal, but for now, the decision is in force. It’s 23 pages of dense reading if you are looking for a sleep aid at the end of a long day.

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I’ve mentioned that I’m on the teaching staff for a leadership seminar for one of my volunteer organizations. The participants will be spending five days with us and we’ll be covering a variety of topics around project planning, team development, managing diverse people, and effective communication. I’ve been prepping for some of my sessions and have three presentations on communication, so I was excited to see the Grammarly State of Business Communication report hit my inbox. It was conducted by Harris Poll on behalf of Grammarly Business and surveyed 1,000 knowledge workers and 250 business leaders. The respondents were full-time workers at corporations with 150 employees or more and were across a mix of industries and job functions. Business leaders were at the director level or higher with decision-making authority over strategy, development, customer experience, budgeting, or hiring.

Findings that caught my attention:

  • The time spent on written communication is up 18% from 2022, but the quality of written communication is waning. This aggregate of 21.4 hours per worker includes writing and responding to written communications, creating materials to be shared, reviewing and editing the work of others, revising materials, and other writing tasks.
  • Effectiveness of written communication has declined 10% over the past year.
  • Miscommunication is frequent, with 100% of respondents reporting miscommunication at least once per week, 66% reporting it once per day, and 48% reporting multiple instances per day. Miscommunication costs US businesses $12,506 per employee per year and comes with decreased productivity and increased worker-reported stress.
  • One in five business leaders feel that inadequate communication has eroded brand reputation, with 19% reporting lost deals due to poor communication. Conversely, one in three leaders feel that effective communication has helped them gain new business.
  • Confident writers are more likely feel confident in their work and engaged in their roles than non-confident writers. They also report higher mental well-being at work.
  • Increases in asynchronous work creates greater urgency for projects aimed at improving the quality of written communication.
  • More than one in five workers report that they have considered finding a new job due to poor communication.

There’s such a great push for many industries to bring workers back to the office that I think people sometimes lose sight of the benefits of asynchronous work. The majority of respondents felt asynchronous communication made their jobs more flexible. Additionally, a good percentage of workers in key demographics felt asynchronous work made them feel more included: 40% each for millennial and Latinx workers, and 39% for neurodivergent workers.

I was particularly interested in learning the details of people’s specific struggles with written communication. The majority of respondents (71%) struggle to choose words that don’t offend others and with finding the balance between formal and casual written speech. Additionally, 63% say they spend too much time trying to convey their message in the right way. There are additional challenges for workers with English as their second or less familiar language, who report higher levels of uncertainty than their primarily English-using colleagues on things like tone, word selection, communication length, jargon, and idioms.

The long and short of it is that communication is key, and I’m looking forward to being part of a leadership development experience that puts some useful skills and well-accepted methodologies in front of people who might not otherwise receive formal communication training. As a side bonus, this is an outdoor leadership program so I get to do all of my teaching in front of a picnic table rather than in front of a Zoom screen. There will also be some sleeping in a tent, which is fine by me, although I’m crossing my fingers for beautiful spring weather rather than the rain and hail I’ve had teaching previous outdoor leadership courses.

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From Bianca Biller: “Re: March is Colorectal Cancer Awareness Month. Look what greeted me on a practice visit. Hopefully the patients will identify with it and get their tests scheduled. The practice had a whole ‘Patient Communication’ wall with at least 10 signs taped to it.” Bianca included a picture of that wall that I can’t run due to the practice letterhead being all over the documents. Some of them are laminated, and based on the photo, they range from knee height (diabetes) to about seven feet from the ground (Affordable Care Act and preventive visits). The fonts were pretty small and I can’t imagine anyone being able to actually read it all. Hopefully they are using other methods to communicate with patients such as their website, patient portal, email outreach, and chatbot campaigns.

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The practice also uses a super fancy inventory management system for the exam rooms, placing the burden of managing inventory on the people who are in direct contact with patients and using the supplies in the rooms. I guess the days of having the staff clean and restock rooms at the end of each day have passed. I understand the “just in time” approach here, but I guess the idea of working at the top of your license might not be top of mind in this practice. Compared to regular checks by support staff, this also increases the risk that you could run out of something if you inadvertently let supplies get lower than the time it takes for someone to notice that the magnets have moved and to find the time to get an item and restock it.

At my last clinical location, there was a designated support staff member that started going through the office with a supply cart in the final hour before closing. Despite seeing up to 20 patients in each exam room each day, we never ran out of anything, we always had what we needed for patient care, and delays were nonexistent. It’s a brave new world, I guess.

As I get ready to head to the American Telemedicine Association’s 2023 Annual Conference & Expo in San Antonio for the first time, I have to reflect on the fact that it is the spammiest conference I’ve ever attended. There are only 220 exhibitors on the list and it feels like I’m getting emails from all of them. Some have a tone of increasing urgency, asking if I missed their previous email and pushing for a response. I understand the sales strategy here, but it’s annoying and actually makes me less likely to consider you as a vendor when you do this. I also loathe emails that address me as “Hey Jayne.” An email isn’t a formal letter and personally I don’t think it needs a salutation. I’d rather receive one with no salutation than one with the “Hey” at the top.

What’s your greatest pet peeve when it comes to email? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/2/23

March 1, 2023 Headlines 2 Comments

Veradigm Inc. Update on 4th Quarter and Full Fiscal Year 2022 Reporting of Results

Veradigm adjusts its 2023 revenue projections after discovering that a compliance software error has caused incorrect revenue reports over the last six quarters.

Press Ganey Announces Collaboration With Epic to Advance Integration of Patient Experience Insight Into Electronic Medical Records

Epic will incorporate Press Ganey’s patient experience data into its MyChart patient portal and Cheers CRM.

VA Deputy Secretary Donald Remy to depart

VA Deputy Secretary Donald Remy will step down from his post, which has included oversight of the department’s troubled EHR modernization program.

Agilon health Announces Acquisition of MphrX, a Leading Healthcare Technology Company

Agilon Health, a physician network development company, acquires FHIR-enabled health data vendor MphrX for $45 million.

Readers Write: Social Determinants of Health and Interoperability

March 1, 2023 Readers Write No Comments

Social Determinants of Health and Interoperability
By Jada Parker

Jada Parker is a public health graduate student at George Washington University.

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Social determinants of health (SDOH) have a huge impact on population health. SDOH can be defined as the conditions and environments where individuals are born, live, learn, work, play, worship, and age. Political determinants of health, such as voting patterns, government makeup, and policies, have led to SDOH and the resulting population health inequities.

SDOH can be divided into five domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social community context. These factors heavily influence health, functioning, and overall quality of life. Care management and community partnerships allow healthcare organizations to address patients’ social needs in areas such as housing, food security, financial assistance, and intimate partner violence.

Health IT can help physicians and clinicians address and understand how SDOH impact their patients’ overall health. Investments in health IT can also support care management in better addressing SDOH to improve patient health.

Interoperability across IT systems plays a pivotal role in addressing SDOH. When organizations can share patient healthcare data, community partnerships are strengthened and providers are able to provide more streamlined referrals to and better coordination with social service resource providers. Resource providers and care management teams are better able to help patients manage chronic conditions as well through care coordination with healthcare providers allowed by interoperability.

Patients who are experiencing homelessness provide a prime use case of how interoperability facilitates care coordination to address SDOH. Homelessness heavily influences overall health, as it may interfere with a patient’s ability to take their medication as prescribed. Homelessness can also result in multiple hospital readmissions for a number of reasons, including poor health management and that a night at the hospital may provide better conditions than a night at a shelter or outside.

Care coordination, improved by interoperability, allows physicians to make social care referrals and share information with necessary outside resource providers. Without interoperability between health IT systems, much of the burden of obtaining and keeping up with paper referrals and records falls on the patient.

Organizations like Administration for Community Living (ACL) provide IT solutions to support healthcare and community-based organizations partnering in order to provide social and whole-health care for the elderly and individuals with disabilities. ACL incorporates open application programming interfaces to provide resource directories through their Open Referral Initiative. These types of IT solutions streamline the referral process, improve care coordination, and strengthen community partnerships .

SDOH data gaps pose limitations to interoperability. However, there are emerging standards for using and sharing SDOH. The Gravity Project is working to define SDOH information so that it may be documented and shared across digital health and human service platforms. ONC Health IT Certification Program and ONC Interoperability Standards Advisory provide many of the current interoperability standards.

Readers Write: How Healthcare is Using AI to Address the Staffing Shortage

March 1, 2023 Readers Write 2 Comments

How Healthcare is Using AI to Address the Staffing Shortage
By Ed Ricks

Ed Ricks, MHA is managing director of healthcare consulting for Baker Tilly US of Chicago, IL.

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One of the greatest challenges facing healthcare providers in 2023 is staffing shortages, particularly among medical doctors and nursing professionals. This stems from a variety of factors, including shifting demographics with an aging Baby Boomer population that is increasing the demand for medical care, a generation of nurses and doctors retiring, the education system not being equipped to create enough new medical professionals, and the demands of the profession that was exacerbated from the coronavirus pandemic.

With staffing shortages not going away any time soon, patients are continuing to experience adverse effecting, including a greater chance for errors, higher morbidity and mortality, employee burnout and dissatisfaction, and patient dissatisfaction, which create a spiraling expense to provider organizations.

Nonetheless, many experts predict that the influence of AI can help address the shortage, so I thought I would ask an AI engine to tell me a story of how AI could help. Here is the response from ChatGPT:

Once upon a time, in a world filled with endless technology, healthcare was facing a major problem. The nursing shortage was plaguing hospitals and nursing homes, leaving patients without proper care.

But then, a group of tech geniuses decided to put their minds together and come up with a solution. They created AI robots designed specifically for the healthcare industry. These robots were programmed with all the knowledge and skills necessary to be a nurse, and they could work 24/7 without taking breaks or getting tired.

At first, people were skeptical about the use of robots in the healthcare field. But as soon as the AI robots started working, everyone was blown away by their efficiency and care. They could do everything a human nurse could do, and they did it better! They never made a mistake, and they never complained about working overtime.

The nursing shortage was soon a thing of the past, and hospitals and nursing homes were able to provide the best possible care to their patients. Everyone was happy, except for the nurses who had been replaced by the robots. But they eventually found other jobs, and they were happy too.

And that, my friends, is the story of how AI robots fixed the nursing shortage in healthcare and made the world a better place. The end.

While this sounds cool, the reality is that proven methods already blend AI technology using computer vision and other input feeds with a repeatable change management framework. By doing so, providers can apply advanced analytics to determine ROI and the best impact opportunities that will lead to dramatic results for their patients and their margins.

Using this type of technology can help harmonize workflows, automate documentation tasks, and simplify communications to give nurses time back to spend with their patients. This leads to reducing friction from the act of providing care. When this type of automation is coupled with a remote nursing and care strategy across an organization with appropriate change management, the results can be far greater.

When combining the use of a proven technology platform with proven outcome driven change management strategies, health systems can see a dramatic impact on reductions in staffing costs, nursing turnover and associated costs, and patient falls. They can also see improved patient outcomes and increased staff and patient satisfaction.

We don’t have to wait for the day that we really have the sentient robots running around delivering full care in health systems. Let’s use the available processes and AI tools now to help providers make a difference on their transformational journey.

Morning Headlines 3/1/23

February 28, 2023 Headlines No Comments

Local Leaders Announce Plan to Strengthen Health Services in Imperial County

UC San Diego Health considers sharing its EHR with El Centro Regional Medical Center as part of its proposal to temporarily take over operational, clinical, and financial management of the financially troubled hospital.

BetterNight Raises $33M Growth Financing Round led by NewSpring.

Virtual sleep care provider BetterNight raises $33 million in a funding round led by NewSpring.

Vouched raises $6.3 million to expand its AI driven identity verification offering to telemedicine and healthcare providers

Vouched will use $6 million in new funding to market its AI-powered identity verification software to virtual and in-person healthcare providers.

News 3/1/23

February 28, 2023 News 14 Comments

Top News

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Cerebral announces its third round of layoffs in the past few months as the beleaguered direct-to-consumer telemedicine company attempts to reorganize and streamline its services.

Cerebral has struggled since the federal government launched an investigation of its prescribing practices for mental health issues, especially its heavily promoted prescribing of Adderall.

Cerebral’s valuation reached nearly $5 billion just over a year ago.


Reader Comments

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From Pete Drucker; “Re: Quil Health. To exit the market, with the last day for employees being February 10 and for executives February 24.” This was sent to me on February 7, but I didn’t mention the company’s name pending verification. Quil’s web page has been taken down and CEO Carina Edwards has updated her LinkedIn with a February 2023 end date and references to the company changed to past tense. Philadelphia-based Quil was formed in 2019 as a joint venture between Independence Health Group and Comcast, offering medical alert and monitoring tools to support care-at-home for seniors. I interviewed Carina Edwards 10 months ago.

From Plural Effusion: “Re: plural words. I see examples daily where someone sticks in an unneeded apostrophe.” Plurals shouldn’t have apostrophes except for one-letter items, such as the Oakland A’s or minding your p’s and q’s.

From You Interviewed Me: “Re: my HIStalk interview. It received lots of attention. You have certainly built an engaged group of readers.” Thanks to this CEO for giving me a rare post-interview report. I’m always up for talking to CIOs, clinician executives, frontline people, or anyone who would be interesting to readers who comes from the non-vendor side of the table. If that’s you and you can spare 30 minutes for a call, let me know.

From Pshaw: “Re: attrition goals. Epic in a nutshell.” Former Amazon managers say that the company meets its attrition goals by rating decent performers as not meeting its expectations. The company refers its “unregretted attrition rate,” where it expects managers to rank 5% of employees in the lowest tier that the company wouldn’t mine losing, voluntarily or otherwise. Amazon replaces a set percentage of less-performing employees annually. UPDATE: I’m changing this since while I was thinking that Epic stack ranks employees and I thought I read long ago that the company’s philosophy was to intentionally replace the bottom tier, I’m not sure that employees in that tier are fired. Perhaps some who works at Epic can elaborate further.


HIStalk Announcements and Requests

HIStalk sponsors benefit from being listed in our guide to major conferences, which provides on-site details for those that are exhibiting or attending so attendees can seek them out. Send me your ViVE 2023 information  by Wednesday, March 15 to be included. The ViVE 2023 exhibit hall floor plan shows 169 exhibiting companies, with separate musical stages for pop, hip hop, bluegrass, classics, and country (the latter being the largest by far, which wouldn’t be a plus for me). Glancing down the exhibitor list, I see a few dozen HIStalk sponsors, so those remaining dozens are welcome to contact Lorre to extend their reach beyond occupying a small patch of carpet for a half week.

Speaking of ViVE, I just got an email saying that the Clearsense-sponsored industry night entertainment is the Black Crowes. Two perpetually feuding brothers are all that’s left of the original lineup that formed 40 years ago, also the only two who played on their monster 1990 album “Shake Your Money Maker” or on their last new album in 2009.


Webinars

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Automated coding technology vendor CodaMetrix raises $55 million in a Series A funding round. The company was spun out of Mass General Brigham in 2019 and is led by former LifeImage CEO Hamid Tabatabaie.


Sales

  • Baptist Memorial Health Care (TN) selects LookDeep Health’s Clinical Action Platform to enhance its inpatient video monitoring capabilities.
  • Augusta University Health (GA) will expand its Virtual Care at Home program using technology from Biofourmis.
  • Southwestern Health Resources (TX) selects referral management software from LeadingReach.
  • Yale New Haven Health (CT) will implement RxLightning’s automated pharmacy workflow software.
  • Sheffield Teaching Hospitals NHS Foundation Trust in England will replace its Dedalus EHR with Oracle Cerner’s Millenium software next year.

People

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Engooden Health, the former Cohort Intelligence, names Tom Frosheiser, MBA (Nvolve)  as CEO.

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Dan Michelson, MBA joins 7wire Ventures as entrepreneur-in-residence, rejoining his former Allscripts executive colleagues Glen Tullman and Lee Shapiro. He was CEO of Strata Decision Technology through May 2022.

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Leah Ray (Jvion) joins Linus Health as chief customer officer.

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Chris Belmont, MBA (Memorial Hospital at Gulfport) joins Ochsner Health as SVP/CIO, a position he held from 2009 to 2013.


Announcements and Implementations

Southern Illinois Healthcare implements PocketHealth’s diagnostic image-sharing software for patients and providers.

NIH-funded researchers from Cleveland Clinic and MetroHealth will use digital twins, created from de-identified EHR data, to understand healthcare disparities based on living location.

A pre-print journal article finds that ChatGPT performs well in suggesting improvements to the logic of clinical decision support alerts.

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Practice management software end users give EClinicalWorks, ModMed, NextGen, and Veradigm top customer satisfaction marks in Black Book’s latest annual survey.


Government and Politics

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HHS OCR renames its Health Information Privacy Division to the Health Information Privacy, Data, and Cybersecurity Division as part of a reorganization that will better enable the office to more effectively respond to complaints. An OCR report published earlier this month pointed out that the office lacks the financial resources it needs to investigate HIPAA complaints and enforce penalties, both of which increased considerably between 2017 and 2021.


Privacy and Security

Researchers at Duke University’s public policy school find that since technology companies, app  vendors, wearables manufacturers, and social media platforms aren’t covered by HIPAA, they are legally selling the health data of their users to data brokers without their knowledge or consent. The authors looked specifically at at mental health data:

  • Some data brokers are offering user health data on the open market, with minimal vetting of customers and few stated limits on its use.
  • Brokers don’t always make it clear whether their health data is de-identified, and some seem to imply that they are willing to provide identifiable data.
  • The most active brokers offered data of people with depression, ADHD, insomnia, ADHD, and bipolar disorder that also included ethnicity, age, gender, ZIP code, religion, number of children living in the home, marital status, net worth, credit score, and data of birth.

Other

It’s not just doctors who are burned out, a Times article says, citing evidence that patients are being burned out by poor healthcare customer service that includes long appointment lead times, short visits, high prices, surprise bills, insurance aggravation, and too much focus on the EHR. Experts say to watch how patients vote with their feet as they flock to non-traditional settings that offer same-day appointments, walk-in visits, flat-rate memberships, and telehealth.

A Stat review of the boards of 15 top-ranked academic medical centers finds that 44% of board members come from the financial sector, while 13% are physicians and 1% are nurses. The authors conclude that board composition may explain why non-profit health systems focus on revenue instead of community need and employee satisfaction. They cite previous surveys showing that a big percentage of hospital board members are white males.


Sponsor Updates

  • Ascom Americas gives Fairchild Communication Systems the ability to re-sell Ascom clinical workflow solutions in the additional market of Toledo, OH.
  • Azara Healthcare and Bamboo Health will exhibit at Rise National March 6-8 in Colorado Springs.
  • Availity will present and exhibit at State HIT Connect March 6-8 in Baltimore.
  • Baker Tilly names Kat Mako (IMethods) and Cindy Kmiecik (Uniper) business development directors of healthcare IT.
  • Bardavon Health Innovations partners with the Gray Institute to offer discounted CEUs to its BNotes customers.
  • Biofourmis, Care.ai, Clearwater, EVisit, and Optum will exhibit at ATA 2023 March 4-6 in San Antonio.
  • CTG publishes a new case study, “CTG Improves Gundersen’s Patient Portal Support with Amazon Connect.”

Blog Posts


Contacts

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

Morning Headlines 2/28/23

February 27, 2023 Headlines No Comments

Cerebral to Cut 15% of Staff in Fresh Round of Layoffs

Cerebral lays off 15% of its staff, part of the direct-to-consumer telemedicine company’s year-long plan to reorganize and streamline its services.

CodaMetrix Closes $55M Series A to Autonomously Power Medical Coding, Boost Health System Revenue Cycles

Automated coding technology vendor CodaMetrix raises $55 million in a Series A funding round led by SignalFire.

Top-Rated Practice Management Systems Align Tech to Transitioning Medical Office Operations, Black Book Annual Physician Survey

Practice management software end users give EClinicalWorks, ModMed, NextGen, and Veradigm top customer satisfaction marks in Black Book’s latest annual survey.

HHS Announces New Divisions Within the Office for Civil Rights to Better Address Growing Need of Enforcement in Recent Years

HHS OCR renames its Health Information Privacy Division to the Health Information Privacy, Data, and Cybersecurity Division as part of a reorganization that will better enable the office to more effectively respond to complaints.

Curbside Consult with Dr. Jayne 2/27/23

February 27, 2023 Dr. Jayne No Comments

I’m headed to several conferences over the next two months. I spent some time this weekend going through the agendas and looking at the details to identify specific sessions I’d like to attend.

Smaller conferences tend to have smaller agendas, so it was fairly easy to determine what I planned to attend at the first of the series, which is the American Telemedicine Association Annual Conference & Expo in San Antonio. Given the frigid weather across most of the US, I have to say I’m looking forward to the San Antonio weather as much as I’m looking forward to any of the sessions. The topics I’m excited about most include remote monitoring, legal issues, and health equity.

Regarding the latter, telehealth holds huge promise, but there is still significant concern that large groups of patients are being left behind due to technology and connectivity issues. My focus is more on health literacy and the barriers it creates as far as care delivery, so it will be interesting to see what the speakers have to say.

The agenda for the CHIME/ViVE mashup was a little more complicated to navigate since it has a lot of sessions that run concurrently across a half dozen different tracks, along with a number of CHIME-only sessions and events. I found a fair amount of overlap in the concepts behind the ViVE tracks and ended up having to really look at the session descriptions versus being able to use the tracks or titles to help thin out the options. I also looked at the speakers and will be making sure to hit sessions with speakers from organizations that are constantly in the news, such as Amazon Clinic and Teladoc.

I didn’t attend ViVE last year, but the way it’s set up seems similar to HLTH. Many of the sessions are focused around experts discussing their opinions. Although those can be interesting, for those of us who have been heavily into evidence-based medicine, we know that when assessing the strength of a recommendation based on a body of evidence, expert opinion is the weakest. When attending those kinds of sessions, I often find myself thinking, “that’s great, but the proof will be in the proverbial pudding,” so I anticipate having that feeling often during the conference.

If you’re going for talks that hit higher up the evidence-based scale, HIMSS is the place to be, at least as far as its concurrent education sessions are concerned. I’ve made fun of HIMSS in the past because the submission timeline for sessions is so far ahead of the conference that material can become stale. However, that significant lead time is useful when you’re performing an advance review of what is going to be presented and assessing it for things like level of evidence and commercial bias. For those sessions where continuing medical education or other credits will be offered, they must include designated learning objectives, along with disclosures of any financial relationships that might be related to the content of the presentations.

Although some of the HIMSS sessions I’ve been to have been dry, they’re usually well put together and the presenters are happy to correspond with you afterwards if you want to dig into their topics. Of course, several of the sessions I’d like to attend are on top of each other, which is a shame. In the past, I’ve found the recorded sessions to be variable in quality, and if I remember correctly, the lower-cost pass I bought for this year doesn’t include access to the recordings. 

Some of the presentations I’m looking forward to at HIMSS cover health equity, standards and interoperability, using automated care programs to improve clinical outcomes, and integrating virtual care with other healthcare delivery options. I’m doing some volunteer work with underserved populations, so I’m particularly interested in one of the sessions on street medicine and delivering care to the homeless. I’ve worked previously with one of the organizations that is presenting and I’m excited to see how their program has grown in the intervening years. It sounds like they’ve added a lot of technology tools to their approach while they still manage to maintain the focus on whole-person care.

It’s always fun to see where people have ended up in this industry, It feels like we were so green trying to do some of these technology initiatives back in the pre-Meaningful Use days. Some of my favorite clinical informaticists have crossed the 20-year mark in the business, so I’m looking forward to catching up with them in any downtime we can find.

Of course, one of the most fun parts of conference season for the HIStalk team is making the rounds at vendor events and reporting on the overall buzz. In the post-COVID era, those vendor events have been fewer in number and lower in key than when healthcare IT was in its more glamorous phases. That’s to be expected given the economy and the fact that marketing folks know that throwing a big bash with a lot of random attendees who don’t even have decision-making authority isn’t likely the best way to spend their cash. Still, if you’re throwing a blowout event where general attendees can register, feel free to send invites our way and we’ll consider anonymously dropping by.

As long as the weather holds, Chicago is one of my favorite cities for HIMSS because it’s easy to get around and has plenty of non-conference activities going on, unlike Orlando, where everything is mostly concentrated in that one section of International Drive. Unlike Las Vegas, you don’t have to walk through a smoky casino to get to where the action is, so that’s a plus.

Several people have told me that Nashville has turned into a fun conference location, although I haven’t been there since one meeting in 2008 that was held entirely at the Gaylord Opryland Resort. I’m looking forward to seeing what it has to offer and will be happy to have the opportunity to catch up with one of my favorite people in her hometown. It’s always good to have a friend who knows where the real fun is to be had and how to avoid the tourist traps and overhyped restaurants and bars.

If you’re taking part in upcoming conferences, what are you looking forward to the most? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Steve House, Managing Director, Baker Tilly US

February 27, 2023 Interviews No Comments

Steve House is managing director of Baker Tilly US of Chicago, IL.

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Tell me about yourself and the company.

I realized the other day that I have entered my 40th year in healthcare. I started back in the early 1980s as a biomedical engineer for Phillips Medical for a decade, and then GE for a decade. I did work for Aetna building ACOs and then Kaiser as a senior director of data. I’ve been around in different spaces around the healthcare environment for a while.

I joined Baker Tilly a year ago. I am a subject matter expert in healthcare. My official title is managing director. I go out and do a lot of strategic work for hospitals, doctors, insurance companies, things like that.

Baker Tilly is fundamentally a tax and audit firm that was started back in the 1930s. It has expanded into all kinds of areas. We have a digital division that does ERP implementation. We have a robust Oracle team. We have an EHR team that was an acquisition of Orchestrate Healthcare. We do strategy service line analysis. We do all types of financial, technical, and clinical sustainability type programs. It’s 6,600 people, almost a billion and a half dollars in revenue, so it is pretty good sized, I think about #9 on the overall consulting size list.

How has health system C-suite leadership changed its thinking about health IT?

It has been a pretty big change and it’s going to be bigger going forward. We have a big labor problem. You have technology like the EHR and work that augments it. That technology is great to have, but it can’t slow doctors down significantly. We have big shortages in primary care, internal medicine, and obviously mass shortages in nursing, so the technology needs to be enabling.

We went through a phase of nearly 20 years where we were getting a handle on the data and making sure that we made it interoperable. It’s not all the way there, but certainly all those things were factors. Now we have to put doctors and nurses in a cockpit of a jet fighter-like concept, where they get the data they need and can make quick, accurate decisions and move them forward. We are in the midst of that transition, and I think it’s absolutely necessary.

Will technology-enabled telehealth and virtual monitoring allow healthcare to become more scalable and then more affordable or more accessible?

Yes. I’m in charge of our hospital-at-home programs. Plenty of people are looking at programs like that, where you are distributing healthcare services differently, in which patients and caregivers become more engaged. You have tools, technologies, social determinants, and an ability to look at it in simplified media formats, like a mobile phone. Suddenly, some of the labor that you need for delivering healthcare services is going to come on behalf of patients and their caregivers themselves as they invest and get engaged in the process. That has the potential to give us the greatest improvement and maybe put us on a path where we can actually succeed in this.

How will patient perceptions of the healthcare system change as more and more physicians become employees of entities whose primary objective is profit?

It’s always going to come down to access first for patients. When you need the system, is it available to you? We have significant access problems because of labor issues. Physicians being employed is, on the face of it, OK as long as you don’t lose productivity and therefore reduce patient access to the system.

But there’s also the other factor, which is that around the world, cost and outcomes — outcomes being lifespan and quality of life — have significant patient incentives. If you’re going to employ doctors and you’re going to have an issue with access because of labor pool problems, the most important next thing you can do is to make sure patients are incentivized to help themselves. You’ve got to make it comfortable and possible for them to manage their own healthcare at some level, and they must be incentivized to do it. Otherwise, it will just become a growing burden cause of aging.

What will happen as ever-larger health systems and insurers encroach on each other’s turf?

A debate has been running in the areas that I travel around the United States about the difference between medical care and healthcare, healthcare being population health, preventative medicine, the things that we do in that category versus, medical care that hospitals and doctors are fundamentally trained to do. If the insurance companies creep into this space in a significant way, the question is, should we think about splitting healthcare and medical care?

In other words, are hospitals and doctors the best places to do preventative medicine, nutrition, counseling, fitness, and weight management? Or did insurance companies find a way to do that part themselves? They try to pay for it, although I don’t think it is always paid for it at a level it should be. But the bottom line is that as they creep in, hopefully they take their biggest incentive — which is reducing variability and outlying costs because people get sick quickly or they’re not maintaining their health — and address that issue directly. If they did that, the system would work better for the patients.

Is it reasonable to expect most people to monitor their own health and use wearables, or is that just a nice idea that will impact only the few people who are willing?

I saw a statistic recently that of all the people who have a gym membership in the United States, somewhere around 4.5% actually use it. I don’t think that’s an indicator that we have got it figured out. Not everybody has to go to the gym, but I was on a task force during COVID and we determined that the average 80-year-old has lost 80% of their lung capacity. That’s obviously a huge danger sign for people with respiratory viruses. The bottom line is no, we have not done a great job of it.

If you take a system like Singapore, they use HSAs, and if you maintain your health and you meet criteria for blood pressure and weight and things like that, many of the dollars that go into your HSA that you’ve saved automatically become your retirement fund, and you don’t pay taxes on it. Those folks over there using that type of system, and they’re not the only ones, do a tremendous job of maintaining their health and staying in shape because they really want to retire. It’s that simple.

What are the technical priorities of health systems?

There’s still a lot of work to be done on the EHR side. Integration work needs to be done to finalize systems. We talk sometimes about a post-EHR implementation world. I don’t think we’re there yet. You have to go from gathering data, stewarding it, and placing governance around it to actually making it more usable. That’s the next phase and hospitals are looking at that.

The other side of healthcare is whether CFOs, CEOs, CMOs, et cetera have enough information to understand how to compete effectively in their own markets. It is still competitive marketing. Competition in healthcare is good for all of us because it drives better and lower costs. We must do a lot better job on financial reporting and cost accounting. We must do better on issues surrounding the data that we provide people so they can make better decisions in their markets.

What parts of health system digital innovation will stick?

Anything that can allow a patient to make a good decision when they need healthcare. If you’re at the mall, start to feel sick, and don’t know what it is, is there’s a kiosk there that gets you good information or provides contact with somebody who can answer your question on whether you should go home and take an NSAID or go to a hospital urgent care? We still haven’t gotten that figured out and we need to. On the patient engagement side, it’s making information available to patients so that they know how to make routine decisions. It’s all online, but not as functionally usable for patients as it needs to be.

As someone who ran for Congress, what do you expect to see from a political standpoint that will make US healthcare different in 10 years?

The one thing that you get when you are in Congress, or are running for Congress, is that there are 10 lobbyists for every member of Congress on the healthcare side. Political will is butting up against the lobbying process that goes on.

There’s a lot of things that should change, including how we manage PBMs, what safe harbor was intended to be back in the 1980s when it was passed, to how we pay for it. Even the fact that Medicare itself is both a payer and a regulator, and when you’re a payer and a regulator, that’s a disconnected process structure and it should change.

Will it change? We’re sitting at 20 or 21% of GDP. A point will come where if it doesn’t change one way or the other, the system is going to break. Some people want single payer, some people want more competition. I’m not a fan of the single-payer idea. I don’t think that’s going to work. But the bottom line is that if something doesn’t change soon, the sheer weight of the cost is going to become a problem that breaks healthcare down.

What factors will be important to the company and the US health system in general over the next few years?

I think it’s process change culture. There’s a lot of cultural issues in healthcare. The first question I ask any healthcare executive these days is, how is your culture? Are you capable of changing? Have you imagined a different environment? Do you have the information and reporting to give you enough decision-making capability?

Some organizations in healthcare have spent a decade or more just training their own leadership on how to make decisions and do it quickly. Healthcare needs to get faster, a lot faster, on the diagnosis side. A lot faster on the change management side. A lot faster on the decision-making side. That’s probably the area where we need to do the most work. Baker Tilly, as a strategic consultant and someone who does operational work, is focused on those areas.

After spending so long in healthcare in my career, I cannot wait to see this next phase, where data use rather than data aggregation and interoperability becomes our priority. What we can do with tools, devices, and modern concepts of how doctors will interact. The average doctor has 16 minutes to spend with their patient, and 11.3 minutes of that is used to input and take data out of an EHR. That’s not an equation that works in the long run. I have confidence that we’re going to see massive quantities of new technology and ideas come up to help solve that problem.

Morning Headlines 2/27/23

February 26, 2023 Headlines No Comments

Biden Proposal Would Ban Online Prescribing of Certain Drugs

The White House proposes a crackdown on telehealth-related prescribing of some medications when the COVID public health emergency ends on May 11.

Gebbs Healthcare Solutions Acquires CPa Medical Billing

Medical billing and coding vendor Gebbs Healthcare Solutions acquires CPa Medical Billing, which offers RCM technologies and services to FQHCs and physician groups.

Vytalize Health Closes $100M to Support Value-Based Care Transformation

Value-based primary care optimization company Vytalize Health secures $100 million in funding, bringing its total raised to $175 million.

Monday Morning Update 2/27/23

February 26, 2023 News No Comments

Top News

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The White House proposes a crackdown on telehealth-related prescribing of some medications when the COVID public health emergency ends on May 11.

Providers would be required to conduct at least one in-person visit before prescribing or refilling Schedule II drugs such as Adderall and opioids.

The DEA says the rule change was prompted by online telehealth companies that took advantage of pandemic-relaxed restrictions to overprescribe drugs such as Adderall, OxyContin,  and ketamine.

The proposed rule would allow prescribing a 30-day supply of Schedule II, IV, and V controlled substances after an initial telemedicine visit, but refills would require the patient to be seen in person. Patients who have seen their practitioner in person or were referred by them to a new practitioner can have all of their prescriptions issued via telehealth visits. 


Reader Comments

From Suzette Crepes: “Re: Teladoc Health. Interesting that it is framing its nearly $14 billion FY22 loss as irrelevant to future success. We use their software and it still is missing features that are in Zoom, Teams, and other software. Reliability is erratic – if a patient receives a phone call during a session, it switches the screen’s focus and disconnects Teladoc. I know some behavioral health clinicians who have left the company and are looking for other opportunities, which are ample, and that may be a worrisome sign.” Unverified. If I were investor in TDOC, I would not find it easy to forgive its executives for satiating their lust for diversified growth by wildly overpaying for Livongo and its skimpy six-year track record. Especially when they failed to make executive retention part of the terms, allowing 11 of the 12 Livongo suits to bail (all but the HR VP). The investor saying to “bet on the jockey, not on the horse” works both ways, and this particular TDOC jockey – who wasn’t a founder and had never been a CEO — was occupying the other end of the steed than Zane Burke. Zane was given the best gift of his life by being disliked by Neal Patterson enough to be passed over for the Cerner CEO job in favor of a far less qualified outsider who had also never been a CEO, allowing Teladoc to make Zane a billionaire in return for his big chair occupancy of less than two years. I don’t know what the TDOC board was thinking, although that of LVGO was surely high-fiving and ka-chinging.

From Benny: “Re: re-imposition of rules requiring an initial in-person visit for prescribing. This is unfortunate, since while a few highly publicized startups were engaging in cavalier practices, most clinicians used this flexibility appropriately. It’s already a challenge to get ADHD care, and stimulants if needed, due to limited availability of professionals, many of whom switched their practices away from in-person healthcare to focus on telehealth. In-person visits are challenging for patients because of transportation and time off from work. Evidence is clear that appropriate treatment ADHD with stimulants improves educational or other outcomes, so this imposed constraint will reduce treatment, worsen outcomes, and increase patient hassle. This will be superimposed on the existing adverse effects of stimulant drug shortages due to regularly constraints placed on manufacturing capacity, of which no evidence exists that it will reduce misuse.” I’m still surprised that DEA is blaming companies rather than individual prescribers, the same as it did with opioid mills where drug distributors paid billions to settle charges for having their products dispensed via the prescriptions of ethically challenged prescribers who were mostly left to keep practicing. ChatGPT could probably spit out a list of shady doctors given only the prescription records of Walgreens or CVS.


HIStalk Announcements and Requests

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Nearly 80% of poll respondents who park at work do so for free, and of those who pay, it’s a 50-50 split between employer-controlled and public parking.

New poll to your right or here: Should physicians be allowed to open and operate hospitals? They can’t for the most part due to Medicare restrictions that were intended to prevent self-referral.


Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


People

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Optimum Healthcare IT hires Jennifer Mahoney, MS (AdventHealth IT) as VP of HR.


Announcements and Implementations

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NHS is testing the use of AI-powered software from Deep Medical to predict the likelihood that a patient will miss their scheduled appointment so that they can be rescheduled in advance. I was briefly entertained by the original version of the announcement (above).

Wolters Kluwer Health launches Lippincott Medical Procedures, a point-of-care guide for performing core procedures, and a new medical and healthcare learning solution called Lippincott Connect.


Government and Politics

An employee health plan sues its health insurance administrator for refusing to turn over claims data that would allow the employer to verify the accuracy of charges against its self-funded health insurance plan. Medical supply vendor Owens & Minor says Anthem Blue Cross and Blue Shield has refused to provide it with claims data since 2021 as required by federal law. Anthem says its claims data involves proprietary arrangements that it doesn’t want to make public. Several similar lawsuits have been settled out of court, with details hidden behind non-disclosure agreements.


Other

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American healthcare in a nutshell: sign-waving protesters demand a change in leadership at struggling Brooklyn hospital Maimonides Medical Center, recruited from Craigslist for $600 per week as part of a $1 million campaign by a group called Save Maimonides that refuses to name its donors. Hospital leaders say the effort is being funded by Eliezer Scheiner, a wealthy operator of a chain of bottom-rated nursing homes who proposed installing 16 new board members of his choosing who would donate $2 million each in holding a majority of the 30 board seats. The hospital says Scheiner wants to gain control over the hospital’s purchasing to steer business to his many supply and services companies. He denies any involvement in the campaign, saying he gave up trying to help the hospital months ago. The money-losing safety net hospital paid its CEO $3.2 million in 2020.

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ProPublica reviews the sprawling family empire that was created by the non-profit Liberty HealthShare, whose healthcare sharing ministry heavily markets its medical insurance alternative to people who didn’t like the political ideology or cost involved with Affordable Care Act policies. The ministry took in $300 million in annually, steering much of it to dozens of businesses that were operated by the same Beers family, who bought an airline, a wedding venue, a marijuana farm, a wholesale carpet chain, a hunting lodge in Canada, and a bank that is now selling services to other healthcare sharing ministries. Healthcare ministries pool customer premiums and pay their bills under their own rules, allowing them to avoid regulation as insurers and to claim religious persecution when investigated. ProPublica found that the ministry collected $1.9 billion in revenue in six years while failing to report $1 billion of that to tax authorities, using self-developed software to make it look as though members controlled their own payments to avoid being regulated as an insurer. The company started rejecting claims and lowballing providers in late 2016, causing at least 50 hospitals – including Intermountain Healthcare – to refuse to negotiate with the ministry.


Sponsor Updates

  • Healing Hands Ministries uses the PRISMA health information search tool of EClinicalWorks.

Blog Posts


Contacts

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

Morning Headlines 2/24/23

February 23, 2023 Headlines 2 Comments

Teladoc (TDOC) Reports Q4 Loss, Tops Revenue Estimates

Teladoc Health reports a $13.7 billion loss for FY 2022, and mixed revenue and earnings results for Q4, prompting the company to consider near-term layoffs and restructuring.

Premier Inc. Acquires 100 Top Hospitals Program

Premier Inc. acquires the “Top 100 Hospitals” program from Merative, formerly IBM Watson Health, which it will integrate with its PINC AI technology and services brand.

Chartis Establishes the Chartis Center for Burnout Solutions

Chartis acquires DES Health Consulting, whose workforce assessment tool will be offered as the Chartis Center for Burnout Solutions.

News 2/24/23

February 23, 2023 News 1 Comment

Top News

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Teladoc Health reports Q4 results: revenue up 15%, EPS –$0.23 versus –$0.07, beating revenue expectations but falling short on earnings.

The company reported a staggering $13.7 billion loss for FY 2022, much of that attributed to goodwill write-downs related to its $18.5 billion acquisition of Livongo in August 2020.

TDOC shares have lost 56% in the past year versus the Dow’s 2% loss, valuing the company at $4.8 billion, having lost about 90% off its value since early 2021.

From the earnings call:

  • CEO Jason Gorevic called Q4 results a strong finish to a “challenging year” in a “more challenging macro environment” that he expects will persist.
  • The company will cut costs, including layoffs and restructuring.
  • Teladoc’s BetterHelp online behavioral health business, which it acquired in early 2015 for $4.5 million, performed well. Teladoc says it has become a billion-dollar business. The company will start reporting performance in two segments, integrated care and BetterHelp.
  • The company expects its employed physicians to eventually conduct more than 50% of visits versus its use of independent contractors, which it says will increase physician productivity and patient satisfaction.

Meanwhile, an outstanding article in MedCity News asks former Livongo CEO Zane Burke directly, “Did you sell a lemon to Teladoc or did they mess up?” Burke says Livongo was a “freaking good business” and that Teladoc was the pursuer of the transaction, but Teladoc’s executives “really liked themselves a lot” and thought they were “clever” in operating a roll-up business versus Livongo’s organic growth and intellectual property. He says Teladoc’s timing was terrible in hindsight and questions why Teladoc’s offer didn’t require Livongo’s executives to stay on board when the acquisition closed, after which 11 of 12 members of Livongo’s leadership team departed.


Reader Comments

From Another NY SR IT Leader: “Re: Sunrise. In addition to Northwell moving to Epic, Altera has Memorial Sloan Kettering, St. Barnabas Bronx, and Brooklyn Hospital all implementing Epic. NYC was once a stronghold for the former Eclipsys Sunrise.”

From Humeris: “Re: HIMSS. Sebastian Krolop, MD, PhD, global COO and strategy officer at HIMSS, has left. Cultural differences with Hal were cited. Another sore spot was his failure to get any traction with Accelerate, the networking platform that he engaged McKinsey to plan and develop.” Verified that he has left after four years, per his LinkedIn post of three weeks ago. As for Accelerate, even HIMSS CEO Hal Wolf hasn’t posted anything, and its LinkedIn page’s last updates were from HIMSS22.


Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Amazon closes its $3.9 billion acquisition of primary care provider One Medical as the Federal Trade Commission fails to challenge the deal by the deadline. FTC has warned the companies that closing the acquisition before its approval is at their own risk, as FTC is still reviewing the transaction. Amazon has already launched a $144 first-year membership in One Medical, which offers 24/7 virtual care via messaging or video, online appointment scheduling, and prescription management. One Medical also runs  physical offices in 22 metro areas that offer on-site lab services. One Medical is a concierge medical practice rather than direct primary care — it bills services to the patient and their insurance like any other non-DPC practice, promising only a more satisfying patient experience.

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Independent primary care network operator Aledade acquires Curia.ai, which offers AI-based value-based care analytics for optimizing patient care and engagement.

Premier Inc. acquires the “Top 100 Hospitals” program from Merative, formerly IBM Watson Health, which it will integrate with its PINC AI technology and services brand.

Chartis acquires DES Health Consulting, whose workforce assessment tool will be offered as the Chartis Center for Burnout Solutions.

Axios reports that healthcare automation startup Olive AI will sell its payer prior authorization business, one of the company’s two remaining business lines. Olive’s headcount has been reduced by more than half via previous asset sales and layoffs.


Sales

  • Memorial Healthcare System implements a virtual care service that is powered by KeyCare’s Epic-based platform.
  • Augusta University Health chooses the turnkey virtual health solution of Biofourmis to expand its Virtual Care at Home program.
  • Silverado will implement hospital and palliative care software and analytics from WellSky.
  • Mount Graham Regional Medical Center (AZ) will implement BridgeHead Software’s HealthStore as a clinical data repository for retired applications.

People

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Benefits administration technology vendor Bridgeway Benefit Technologies hires Todd Plesko, MBA (GHX) as CEO. He replaces Jenny Morgan, MS, who will retire and serve as board chair.

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Deborah Norton, MBA, who retired as CIO/SVP for operations from Harvard Pilgrim Health Care in  mid-2021,  died Saturday at 69.


Announcements and Implementations

A new KLAS report on long-term care EHRs finds that PointClickCare has the highest market share and customer satisfaction, while Epic performs well for health system-owned LTCs.

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Ambience Healthcare launches an AI-powered, human-free medical scribe that embeds in EHR workflow to allow providers to review, edit, and sign off on their notes nearly immediately. The company has raised $30 million through a Series A round.


Government and Politics

A VA official warns that the problem that forced a delay in the planned Oracle Cerner go-live at its Ann Arbor operation, which it announced last week, is likely to affect any VA hospital that conducts clinical research and needs integration with research-based systems.

Companies may no longer require laid-off employees to sign confidentiality agreements or non-disparagement clauses as a condition of receiving severance benefits, per a National Labor Relations Board ruling that takes effect immediately.

The American Hospital Association writes a letter of opposition to the FTC’s proposed rule that would prohibit employee non-compete agreements. AHA says that FTC doesn’t have the authority to enforce the rule, it would affect only new agreements since FTC doesn’t have retroactive authority, the rule should not apply to highly paid hospital executives and physicians, and FTC does not have legal authority over non-profit entities and therefore a non-compete ban would place for-profit hospitals at a disadvantage.


Other

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Folks who tamp ear wax into their skulls by using Q-tips like Civil War cannon rammers might want to swap out for Smart Visual Ear Cleaner, a $30 smartphone-paired tool that features an in-ear camera and a series of silicone scrapers. Although I might spring an extra $5 for the Bebird version that Best Buy sells (pictured above). Some people are addicted to shoving swabs into their ears with the regularity of brushing teeth, sometimes puncturing their ear drum and surely knowing from a basic anatomical standpoint that it’s a bad idea. The third, non-technical hygiene option is perhaps best – use an ear wax removal kit that contains a peroxide solution that fizzes wax right out, which offers comfort of knowing it is working by the sounds of percolation that seem to emanate from deep inside your head and the trickle of the resulting output running down your cheek.


Sponsor Updates

  • Ellkay will exhibit at Rise National March 6-8 in Colorado Springs.
  • GHX has been named a Notable Vendor in the 2022 Gartner Vertical Industry Context: ‘Magic Quadrant for Multienterprise Supply Chain Business Networks.’
  • InterSystems announces that its HealthShare Unified Care Record has earned a Certified Data Partner designation from NCQA’s Data Aggregator Validation Program.
  • Clearsense posts a new case study, “Accelerating Research and Delivering Enhanced Patient Insights with Population Health.”
  • VA names NeuroFlow one of the winners of its Mission Daybreak Grand Challenge, designed to discover new solutions to reduce veteran suicides.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 2/23/23

February 23, 2023 Dr. Jayne 4 Comments

In the “not a major surprise, but it’s nice to see some data” category, a recent study published in the Journal Healthcare finds that scribes are linked to a 27% reduction in primary care burnout rates. The authors looked at using remote scribes to assist primary care physicians in an effort to boost physician wellness.

The research was performed at University of Wisconsin Health and included approximately 200 physicians in the specialties of family medicine, general internal medicine, general pediatrics, and adolescent medicine. Individual scribes were paired one-to-one with physicians. The intervention group included 37 physicians and the control group numbered 160. The scribes used an audio-only cellphone connection to listen to visits and create documentation in real time. Orders were entered and held in a pending status for physicians to execute. The final notes also underwent review, editing, and signature by the physicians.

Prior to the intervention, more than 70% of physicians reported burnout. Post-intervention, that number was down to 51%. Although that change is dramatic, it is accentuated by the fact that for those physicians who didn’t work with a scribe, their burnout rates rose from 50% to 60%. Additionally, those working with scribes were more likely to describe their workplace as “joyful” and “supportive.” Measures of EHR-related stress were lower than those clinicians who didn’t have scribes. Working with a scribe slashed up to 66 minutes of EHR time out of an eight-hour physician day, with half of that being outside the scheduled workday.

Interestingly, looking at the study design, those receiving scribes were self-selected and had to agree to not only participate in program evaluation efforts, but to see one additional patient per half-day clinic session in order to offset the costs of the scribe. Both of those factors may have had an influence on satisfaction.

The authors noted that four of the intervention group dropped out of the project within the first year, and it would be interesting to look at the reasons given. They also noted that the project began just prior to the COVID-19 pandemic, “which dramatically disrupted clinical operations and could have affected the post-intervention wellness and EHR measurements.” Still, they conclude that “the fact that a scribe program can be revenue-neutral with modest increases in productivity makes them an attractive intervention to help organizations improve the wellness of their physician workforce.”

I think that if primary care colleagues fully did the math, many of them would be willing to see one or two more patients per day in order to shave time off their after-hours documentation.

Working with scribes was critical to my survival in the early days of the pandemic, when my urgent care’s volumes spiked. It would have been impossible to see 80+ patients per day without a scribe. A good chunk of those visits were for COVID testing or COVID concerns without any symptoms, and my scribes were able to capture not on the patients’ stories, but all of my counseling and medical advice, before I left the room.

Unfortunately, many of our practice’s best scribes gained admittance to medical school in the summer of 2020, decimating the program. It wasn’t able to recover prior to the subsequent COVID peaks, and the lack of scribes was directly associated with a number of physicians leaving the organization in the first half of 2021. There is definitely some work effort involved in onboarding a scribe program, but if your organization is experiencing clinician burnout, it’s worth considering.

My Approved Portraits

Senator Tammy Baldwin of Wisconsin is going after health system Ascension. In a letter to the health system’s CEO, she calls out the fact that “Ascension is required to provide charitable benefits to the community and operate solely to serve a public, rather than a private interest. Despite these requirements, Ascension has significant for-profit investment activities that dwarf what the system providers in annual charity care.” She goes on to state that “by operating like a private equity fund, Ascension is squeezing staff, closing facilities, and extracting cash from its member hospitals for dubious ‘management fees’ all to advance its investment activities and provide compensation to its executives.”

Baldwin also calls out the fact that at the recent J.P. Morgan Healthcare Conference, Ascension’s CEO talked up its $18 billion in cash and investments, noting “This number raises questions about why Ascension, a mission-driven health system with non-profit status, is not prioritizing reinvestment into serving vulnerable communities and its own operations – which should include increasing pay and improving working conditions for its burned out and overextended health care workforce.”

She cites data that Ascensions investment funds lost the system more than $200 million more than the organization provided toward charity care during the most recent financial quarter. She closes with a demand for data covering fiscal years 2015 through 2022 that describes investments, returns, charity spend, debt collection practices. She also asks for information on management fees charged to hospitals, how monies from the Provider Relief Fund were used to address hospital staffing, details on over $250 million in charitable care during the last three months, and a list of compensation packages for executives and board members.

I’ve worked for several health systems that sat on billions of dollars while the proverbial city burned. I’ve seen essential frontline workers struggle to maintain full-time status while managers are incentivized to turn them into part-time workers so they don’t have to pay benefits. I’ve seen these systems put the squeeze on primary care physicians while they build fancy non-clinical additions on their buildings. And we’ve all seen some of these organizations aggressively pursue patients for their portion of payments, while barely paying heed to their supposed charitable missions.

On my most recent patient-side visit to one of these systems, I experienced understaffing, scheduling issues, and dirty facilities. With cash in the double-digit billions, it feels like they shouldn’t have baseball-sized dust bunnies in the waiting room. They also shouldn’t be shifting patients away from established physician relationships to brand new mid-level providers because the physician panels are full and they “can’t afford to hire” additional physicians.

It will be interesting to see how this plays out with Ascension, and I’m sure other nonprofits will be following closely.

What do you think about so-called non-profit health systems who have billions in the bank? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/23/23

February 22, 2023 Headlines No Comments

New Releases: SDOH Toolkit and Learning Forum Sessions for the Health IT Community

ONC publishes the “Social Determinants of Health Information Exchange Toolkit” to serve as a resource for healthcare stakeholders as they consider incorporating social determinants of health into the design of health IT systems.

Scoop: Olive AI plans to divest second major business line

Healthcare automation vendor Olive AI reportedly considers selling its payer-facing prior authorization business.

Amazon closes deal to buy primary care provider One Medical

Amazon closes its $3.9 billion acquisition of membership-based primary care provider One Medical, which has 200 clinics in 26 markets.

Morning Headlines 2/22/23

February 21, 2023 Headlines No Comments

AGS Acquires Offshore Patient Access BPO Unit from Availity

AGS Health acquires the India-based patient access outsourcing business of Availity, which adds 200 team members to AGS Health’s 11,000 RCM experts.

Ventra Health Announces Acquisition of Deras Global

RCM services provider Ventra Health acquires Deras Global Services, a Philippines-based provider of RCM services for hospital-based physician specialties.

Aledade Adds More Than 450 New Practices for 2023, Making It the Largest Network of Independent Primary Care in the Country

Independent primary care practice management company Aledade acquires value-based care analytics vendor Curia for an undisclosed sum.

News 2/22/23

February 21, 2023 News 3 Comments

Top News

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ONC publishes “Social Determinants of Health Information Exchange Toolkit.”


Reader Comments

From NY CIO: “Re: Northwell Health. Word is it will announce its move to Epic and that it will bring a large number of their Allscripts-outsourced employees back in-house.” Unverified. I’ve been watching the Northwell job site, which lists a handful of positions that include Epic implementation.


HIStalk Announcements and Requests

ViVE and HIMSS23 exhibitors: the conferences will have come and gone within a few weeks, but contact Lorre if you want a full year of HIStalk sponsor exposure for little more than you’ll spend on coffee for your booth people.

This seems like an interesting webinar topic with a compelling title that I ran across on LinkedIn: “TEFCA Kills the National Networks: Or Does it?” offered by Zen Healthcare IT.


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Welcome to new HIStalk Platinum Sponsor Mobile Heartbeat. The Waltham, MA-based company offers the health industry’s leading unified clinical communication and collaboration solution. The MH-CURE platform securely engages colleagues across every department and accelerates decision-making, improves care delivery, and increases patient throughput. Its scalability and reliability is evidenced by a robust user base of 260,000 active users and 130,000 deployed iPhones. Open architecture, anchored in standards-based API, supports both innovation and integration with third-party solutions. Adoption-driven pricing model with unlimited users and a bed-based pricing structure encourages widespread adoption. Thanks to Mobile Heartbeat for supporting HIStalk.


Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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AGS Health acquires the India-based patient access outsourcing business of Availity, which adds 200 team members to AGS Health’s 11,000 RCM experts.

RCM services provider Ventra Health acquires Deras Global Services, a Philippines-based provider of RCM services for hospital-based physician specialties.

HealthStream announces Q4 results: revenue up 7%, EPS $0.08 versus –$0.01. HSTM shares are up 3% in the past 12 months versus the Nasdaq’s 15% loss, valuing the company at $800 million.

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A new American Hospital Association report covers recent developments involving retail, payer, and technology disruptors of healthcare in the $260 billion primary care market:

  • Amazon. Will acquire primary care provider One Medical for $3.9 billion pending FTC approval. Added the RxPass generic medication program. Offers home lab testing. Uses AWS to drive innovation. Runs a healthcare accelerator and has invested in disease management.
  • CVS Health. Markets its services to health plan customers that were acquired with its purchase of Aetna. Will expand its HealthHUB to 1,500 locations. Will acquire primary care provider Oak Street Health for $10.6 billion pending FTC approval. Acquired home health company Signify Health for $8 billion. Has expanded its virtual mental health services. Will create health subscription models and commercialize its data and analytics. Has high usage of its CarePass program for free medication delivery and its self-serve digital tool for completing pre-appointment forms. Will spend $3 billion to expand its digital offerings and improve the customer experience. Runs a $100 million early-stage digital health venture fund.
  • UnitedHealth Group. Will process transactions for 85 million patients via its merger with Change Healthcare. Has funded multiple virtual behavior health providers. Invested in care coordination companies and a provider credentialing vendor. Has invested in several tech-heavy remote patient monitoring and home care companies along with several virtual care solution vendors.
  • Walgreens Boots Alliance. Acquired two-thirds interest in primary care provider VillageMD and will have 1,000 practices by 2027. Is buying Summit Health, which operates urgent care provider CityMD, for $8.9 billion. Acquired specialty pharmacy Shields Health Solution. Paid $330 million for controlling interest in CareCentrix, which manages patients in their homes.
  • Walmart. Is continuing to open freestanding health centers. Acquired telehealth provider MeMD last year. Is partnering to extend value-based care to Medicare beneficiaries. Works with Epic to enhance communication and information sharing.
  • Apple. Is creating relationships with payers, health systems, and researchers via health-related features for the Watch and IPhone.
  • Google/Alphabet. Collects health information via Google Fit. Is actively working with drug companies to cut drug development costs via AI. Is focusing on, and investing in, the use of AI ii radiology. Has launched three Health Data Engine accelerators.

Sales

  • Lifepoint Health will use virtual care technology from Midi Health to launch a telemedicine service for women experiencing perimenopause and menopause.

People

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Mass General Brigham hires Rebecca Mishuris, MD, MPH, MS (Boston Medical Center) as VP/CMIO.

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Greg Kidd (Glytec) joins Revuud as regional VP.

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Zachary Lipton, PhD (Amazon AI) joins clinical documentation company Abridge as chief scientific officer.

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Nancy Heininger (Athenahealth) joins Koan Health as RVP of sales.

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XiFin, parent company of OmniSys, promotes Scott Warshaw, MPA to chief strategy officer.


Announcements and Implementations

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The Sequoia Project launches a Consumer Voices Workgroup to learn first-hand about the barriers they experience while accessing, using, and sharing their health information. Nearly all of the members serve as caregivers for patient, 80% of whom don’t use technology.

Sunrise Mountain Family Medical Clinic (NV) implements cloud-based EHR technology from EClinicalWorks.

Infor launches a module for its Workforce Management suite that analyzes EHR data to measure workload for each patient to support nurse scheduling and reduce overtime.

Redox will offer its interoperability systems on Google Cloud.


Government and Politics

President Biden upholds an International Trade Commission ruling that could ban importation of the Apple Watch over EKG patent complaints filed by AliveCor. Masimo has also sued Apple over pulse oximetry patents and has won an initial ruling, which could also apply an import ban to some versions of the Watch. Apple has appealed the AliveCor decision, and experts say that even if Apple loses either decision, it will probably just negotiate a licensing fee with the plaintiff.

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HHS OCR reports that large HIPAA breaches jumped 58% between 2017 and 2021, with HIPAA complaints spiking 39% in that same timeframe. The office says that its funding has not kept up with these increases, limiting its HIPAA enforcement capabilities.

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The federal government shuts down Missouri non-profit Medical Cost Sharing Inc., a healthcare cost-sharing ministry that took in $7.5 million in membership fees while paying out only $246,000 to cover the submitted healthcare bills of members. The two founders pocketed at least $4 million for running a minimally regulated ministry whose members pay premiums that are used to cover the medical bills of other members. Medical Cost Sharing, which required members to attend church and abstain from using drugs and alcohol, offered plans starting at $90 per month that included telemedicine and discounts on visits with its in-network providers.


Privacy and Security

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Lehigh Valley Health Network (PA) refuses to pay the ransom that was demanded by hackers who breached a radiation oncology imaging computer at one of its physician practices.

Tallahassee Memorial HealthCare (FL) restores its computer systems and resumes normal operations 13 days after an unspecified security incident. Sources have suggested that the hospital had been waiting on an insurance payout to meet ransomware demands.


Other

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The New York Times looks at the telehealth-powered growth in prescriptions of the psychedelic-like drug ketamine, also known as club drug Special K, whose use has expanded from surgery sedation to treating mental health conditions, frequently for unapproved uses and supplied by compounding pharmacies that operate outside FDA’s oversight. The authors note the narrowing gap between legitimate medical treatment and online shopping. Online seller Joyous charges $129 per month for a telehealth consultation, medication delivered to the customer’s home, and daily text messages for adjusting dose.

Optum Tri-State CEO Kevin Conroy responds to patient complaints about delays in scheduling appointments, requesting refills, and connecting with care team members, pledging to improve its call center operations, add clinicians, and extend hours. Optum’s Medical Care practice, formerly CareMount Medical PC, stationed a security guard outside of one of its urgent care facilities late last year as tensions rose over service issues.

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A study of the low credit scores of residents of Southern states finds that medical debt is a key contributor, driven by the high prevalence of chronic disease and having eight of the 11 states that haven’t expanded Medicaid. A new policy change will eliminate the two-thirds of medical debt collections from credit reports that involve balances under $500, but people in the South are more likely to have debt over that threshold.


Sponsor Updates

  • An Arrive Health analysis of 78 million prescription transactions finds that its Real-Time Prescription Benefit solution surfaces 37 million transactions in which a $0 medication is available.
  • Bamboo Health will exhibit and Diameter Health will present at the State Healthcare IT Connect Summit March 6-8 in Baltimore.
  • Nordic releases a new episode of its “Designing for Health” podcast featuring Memora Health’s Omar Nagji.
  • HealthMark Group CEO Bart Howe, MBA is elected president of the Association of Health Information Outsourcing Services.

Blog Posts


Contacts

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