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Above the Fold

Will HIMSS Bring About World Peace?

Apr 20, 2015• 2

By MICHAEL MILLENSON

I had a HIMSS 2015 hallucination.

Walking through the crowded exhibit halls of the premier health information technology trade show, the Prophet Isaiah’s vision of beating swords into plowshares and the lion lying down with the lamb suddenly unfolded before my eyes. Even if we were in McCormick Place in Chicago, not the Temple Mount in Jerusalem. (Although we were on an upper level.)

There ahead of me, the maker of the A-10 Thunderbolt “tank buster” dwelled in a booth a few steps from a maker of fasteners for tractor engines: sword and plowshare. Elsewhere, the PAC-3 missile manufacturer contentedly cohabitated with a company that sells baby strollers: lion and lamb.

However, what prompted this copacetic condition was not a prophet, but profits. As tens of billions of dollars pour into digital technology to improve the efficiency and effectiveness of U.S. health care, companies large and small all want a cut.

The attack plane manufacturer and the missile maker? Lockheed Martin andNorthrop Grumman respectively, both of which also sell electronic health records and health information management systems.
The tractor engine fastener? Made by the Spiralock division of Stanley Black & Decker SWK +1.15%, whose Stanley Healthcare unit sells a “solution set” for clinical operations and workflow.
Baby strollers? They’re from the Graco unit of Newell Rubbermaid NWL +0.98%, whose Rubbermaid Healthcare division advertises mobile computing solutions and “providing caregiver workflow advantage.”

“Swords into plowshares” at HIMSS 2015?

Total U.S. spending on health care is closing in on a staggering $3 trillion.Entrepreneurs from everywhere in the economy are making a pilgrimage to this sector. Venture capital funding in health IT roared to $4.7 billion in 2014, according to the Mercom Capital Group, more than double the $2.2 billion in 2013. Small wonder that more than 42,000 attendees flocked to HIMSS this year, a jump of some 10,000 from as recently as 2011.

Here’s where we come to the part about world peace. The U.S. health care system is by no means the only one needing modernization and rationalization. Several years ago, HIMSS issued awhite paper examining electronic health records from a global perspective. The group now boasts regional offices and puts on events in Europe and Asia. As global capital markets recognize the potential of health IT, it’s not too much to hope that individuals of all religions, races and nationalities can come together in search of the “new, new thing,” the next big deal and the large pot of cash that comes with both.

Ideology is one thing, but, as the saying goes, business is business. Co-existence fostered by capitalism.

Admittedly, this isn’t quite what Isaiah had in mind. Still, if a prominent Middle Eastern country decides to switch from centrifuges to Software As a Service, I’ll be looking for the Iranian booth at HIMSS next year.

HIMSS15 Wrap up

Apr 19, 2015• 1

By MICHELLE RONAN NOTEBOOM

It’s taken me two days to recover from 3-1/2 days of HIMSS15 and I wonder how the other 43,138 attendees are faring. Actually I am pretty confident that few people escaped Chicago without swollen feet and exhausted minds and bodies.

The convention is a mammoth event that offers a little something for everyone, whether you are interested in policy, technology, education, networking, buying, or selling. Some folks, including Greg Rakas of epatientfinder, believes the event is almost too big and overwhelming. In Greg’s words, “We have the most professional people and vendors in all of medicine there resorting to magicians and games of chance to lure people in. I found that to be a little disappointing and pandering.”

Others, like Houston Johnson, CEO of Practice Insight, were quite satisfied with the overall experience. “We met with many of our partners and that’s really why we come here,” Johnson shared. “It gives us a chance to talk to our existing resellers and meet new resellers.”

The exhibit hall – which supposedly measures 22 football fields – creates a bit of a sensory overload. While walking the floor with a friend of mine, he remarked that it’s a bit like New York City with all the big crowds and flashing lights. Over 1,000 exhibitors pay thousands of dollars for the opportunity to draw the attention to their offerings, hence the magicians, late afternoon cocktail receptions, and iPad, Apple Watch, and GoPro giveaways.

Five Years of Failing Patients

Apr 17, 2015• 3

By ANGELO VOLANDES, MD

Although this March marked the fifth anniversary of passage of the Affordable Care Act many of its promises to place patients at the center of care remain elusive. No where is this more evident than in the law’s provision to improve shared decision making.

Oftentimes there is more than one reasonable medical treatment to choose from. Shared decision making helps patients partner with health care providers to make more informed decisions about treatments based on patients’ personal beliefs and values and their informed understanding of their medical choices. Frequently, patients are simply told what course of treatment they are to undergo without considering alternatives.

A well-accepted path towards aligning patients’ preferences with medical care is to use decision aids. These tools include written educational materials, informed face-to face encounters, or videos with instructional images that explore different options for care by providing the risks and benefits of interventions and their alternatives, exploring individual values and preferences, and offering testimonials from other patients who have experienced the various choices.

It is an astounding fact that after five years the Centers for Medicare and Medicaid Services (CMS) has certified only a single decision aid. Even in a city infamous for bureaucracy, this is inefficient at best – especially given that the overwhelming number of studies demonstrate that decision aids align medical care with what patients want, while also saving the health care system billions of dollars.

In Defense of Epic. No, Really!

Apr 17, 2015• 20

By ROBERT WACHTER, MD

Today THCB is delighted to feature an excerpt from Robert Wachter’s much-talked about new book “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age“ (McGraw Hill, 2015). If you enjoy this piece, be sure have a look at the director’s cut interviews Wachter did for the book with Atul Gawande: “Computers Replacing Doctors“, and John Halamka: “Black Turtlenecks, Data Fiends & Code.” — John Irvine

That Epic would find itself labeled a monopoly is in itself an extraordinary turn of events. In 2000, after 21 years in business, the company had only 400 employees and 73 clients, and did not appear on a list of the top 20 hospital EHR vendors. Its big break came in 2003, when the 8 million–member Kaiser Permanente system selected Epic over two far better known competitors, IBM and Cerner. The cost to build Kaiser’s electronic health record: $4 billion.

Today, Epic has 8,100 employees, 315 clients, and yearly revenues of approximately $2 billion. The system is now deployed in 9 of the US News & World Report’s “Top 10” hospitals. In 2014, the company estimated that 173 million people (54 percent of the U.S. population) had at least some medical information in an Epic electronic record.

Epic Founder and CEO Judy Faulkner’s vision, built on several central tenets, has been vindicated many times over. The first principle was that the winning EHR vendor would be the one that solved the most problems for its customers.

While Apple’s App Store has made a modular environment seem feasible and even desirable, most healthcare decision makers want a single product that does everything they need right out of the box (physician notes, nursing notes, drug ordering and dispensing, billing, compliance, and population health) and does those things everywhere, from the newborn nursery to the urology clinic to the ICU.

Last Chance for Meaningful Use

Apr 16, 2015• 14

By ADRIAN GROPPER, MD

I mean: Last chance for patients as first-class citizens in Meaningful Use.

The ghetto is abuzz. As I write this #nomuwithoutme is just hitting Twitter. The reason the natives are restless in the patient ghetto is a recent proposal by our Federal regulators to downgrade a Meaningful Use (MU) requirement for Stage 3, in the final stage of a $30B + initiative to advance interoperable digital health records. The focus is on something called View / Download / Transmit (V/D/T) but the real issue and the Last Chance is broader and more important. The bad news is that MU may leave patients as beggars for own data. The good news is that the Office of the National Coordinator (ONC) and Congress are paying attention and patients still have a chance to shift the terms of the debate to what HIPAA calls “the patient’s right of access” and demand that it apply strictly to MU Stage 3 Appication Programming Interfaces (API).

To find the core of the downgrade, search the Notice of Proposed Rulemaking NPRM for the word “download”. To experience the ghetto first-hand, search the NPRM for “4 business days”. The issue is plain: patients are to get degraded, delayed information through a “portal” that forces us to take whatever the “providers” are willing to grant us.

Designing For Good: A Designer’s Hippocratic Oath

Apr 16, 2015• 2

By MAD*POW

The Designer’s Oath brings together designers from disparate disciplines and backgrounds to create collaborative Oaths that speak across design practices and organizations. The traditional boundaries of design are quickly expanding, and our code of ethics needs to be as flexible and easy to redefine as the process of design itself. The Designer’s Oath must become a tool that is applied to the process of design to ensure that the end result does good.

Surviving the Affordable Care Act Grace Period

Apr 16, 2015

By KATHY YOUNG

Since the first open enrollment in 2014 more than 11 million people have gotten coverage through the insurance exchanges established through the Affordable Care Act (ACA). While the plans offered through the exchanges are provided by the same insurers you deal with every day, there are some differences.

The biggest one is the 90-day grace period. As we near the end of the grace period for 2015, many practices are still struggling to manage the ins and outs to ensure they get paid. Here’s why.

When a person goes into the exchange to select a policy, they get a 90-day grace period to pay premiums. This grace period is between the insurance company and the policy holder. As with other coverage, when the patient makes an appointment and/or goes to the doctor, he or she shows the insurance card. When the practice verifies eligibility, it shows that the patient is covered. If the patient comes into the office during the grace period, the claim will go out as usual and get paid. However, if the patient did not pay their premium during this grace period, the insurance company will come back to the practice and ask for the money back. Then, the practice has to bill the patient directly. This is difficult for providers for many reasons, not the least of which is that the longer it takes to bill a patient, the lower the chances of getting paid.

As a provider you may feel a strong reaction to this 90-day grace period and want to wait to see patients until the grace period is past. This is probably not realistic. Patients need care, and you need to have a positive relationship with your patients. So, here are a few steps to help manage the grace period and ensure you get paid:

If the patient is in this grace period, ask them to bring proof of payment of their premium (cancelled check or receipt of some kind).
If the patient cannot provide this, have them pay at least 50% of the billed charges at the time of service.
Have patients sign a contract that states that they will pay the charges if the payer denies them or asks for the payment back after services are rendered.
Implement a credit card on file option. Patients provide a credit or debit card and sign a contract that it can be charged up to a specified amount (i.e., $150). If the payer denies the claim or asks for the payment back, the practice can charge the card and send a receipt to the patient.

Over 30% of physicians believe that the largest barrier to good healthcare is inadequate insurance coverage. So it is no wonder that over 40% of physicians also believe that the Affordable Care Act is mostly good and a similar number are accepting exchange plans. However, this doesn’t change the fact that the new plans come with challenges.

As a small business you can’t really afford to wait too long to get paid, or worse, have to return payments and then wait again. By implementing some simple steps now you can help reduce the headaches of exchanges plans in the years to come.

Kathleen Young is the CEO and co-founder of Resolutions Billing & Consulting, Inc., which was founded in 2003. Kathleen is also the owner of Healthcare Chart Audits, which offers auditing to physicians and attorneys. Kathleen has been in healthcare since 1989 and has worked for physicians, large corporations and three billing companies. Kathleen is a CPC and a CPMA with the American Academy of Professional Coders and speaks to many groups on coding, billing, and auditing.

The Big Fix. Medicare Doc Pay Enters a New Era

Apr 15, 2015• 6

By STEVEN FINDLAY

It’s done. Congress on April 14 passed and the president signed into law a bill that terminates one of the most egregious and silliest examples of dysfunctional government in recent years—the so-called “sustainable growth rate” (SGR) formula for doctors’ fees under Medicare.

A previous blog explained the background and protracted lead-up to this moment.

Now what?

First, a round of applause for bipartisan agreement—however obvious it was that had to happen in this case. The vote in the house was 392-37. In the Senate, it was 92-8.

Praise is also in order for enacting two more years of funding for the Children’s Health Insurance Program and $7.2 billion in new funding over two years for community health centers, a program that was expanded under the Affordable Care Act and serves low-income families. There’s also welcome help for low-income Medicare beneficiaries and rural hospitals.

But the main thrust of the law is to kill one (failed) program that adjusted doctors’ fees under Medicare and create a new and hopefully better one.

Time For a Stand Against Misinformation

Apr 15, 2015• 3

By SUSANNAH FOX

Two years ago, I interrupted a speaker at a big health/tech conference, right in the middle of his presentation. I still blush at the memory. But the speaker was citing data — my data—incorrectly and I couldn’t let it pass.

Brian Dolan recently wrote about how he wished he’d spoken up when he heard someone spreading misinformation at a conference:

Unfortunately, about 80 people sitting in the room either accepted this as new information or failed to stand up to correct the speaker. I wish I had pulled a Susannah Fox and done the latter.

He linked to my 2012 post about what happened at Stanford Medicine X.

In that post I asked:

What style of conference is the right one for the health/tech field? The TED-style “sage on stage” who does not take questions? Or the scientific-meeting style of engaged debate? Or is there a place for both?
Do different rules apply to start-ups? Is it OK to fudge a little bit to make a good point, as one might do in a pitch? Personally, I do not think people are entitled to their own facts. There’s too much at stake.

We can’t let misinformation—or worse—go by without comment.

I think it’s time for more people to speak up in health care.

More pediatricians should express their measles outrage.

More people should chronicle the reality of living with chronic conditions.

More people wearing medical devices should demand access to the data being collected.

More people should speak up about medical errors before—and after—they happen.