The Health Care Blog – Page 426 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Will Independent Physicians Go Extinct?

Apr 1, 2015• 21

By RICHARD GUNDERMAN, MD and MATT ALBIN, MD

Life is tough for physicians in solo and small group practice. The federally mandated introduction this fall of ICD-10 requires physicians and their staffs to learn a new system of coding diseases. “Meaningful Use,” another federal program, requires physicians to install and use electronic health records systems, which are complex and expensive. And PQRS, the Physician Quality Reporting System, is beginning to penalize physicians for failing to report individual data for up to 110 quality measures, such as patient immunizations, each of which takes time to collect and record.

Of course, such requirements are not being imposed solely on solo and small-group physicians. In many ways, they affect all physicians alike. Yet the burdens of complying are disproportionately high for small groups, which cannot spread out the costs of purchasing equipment, hiring employees and consultants, and training personnel over so large a number of colleagues. Hospitals and large medical groups can afford to hire full-time specialists to meet these challenges, but such approaches are not economically feasible for a group that consists of only a few physicians.

Such challenges are not just raining down – they are pouring down on the heads of physicians. Some physicians fear they smell a conspiracy to drive solo and small-group practitioners out of business. And the problem is not just the money. It’s also the time. Many physicians already work long hours and simply cannot afford to shop for such systems, negotiate contracts, and enter data. We personally know physicians who report spending two hours each evening completing records that they did not have time to attend to while they were seeing patients.

HIT Newser: Big Win for Epic in San Diego

Apr 1, 2015• 5

By MICHELLE RONAN NOTEBOOM

Epic Scores Another Big Win

Scripps Health selects Epic to replace its existing GE Healthcare’s Centricity Enterprise (inpatient) and Allscripts Enterprise (outpatient). The San Diego-based Scripps includes five acute-care campuses, 26 outpatient clinics, and 2,600 affiliated physicians.

No doubt that this is one that Cerner had hoped to win.

Marlin Equity Partners Acquires e-MDs

Marlin Equity Partners acquires ambulatory EMR provider e-MDs. Marlin will merge e-MDs with its existing portfolio company MDeverywhere, a provider of RCM and credentialing services for physicians. e-MD founderContinue reading…

Let’s Play “What If”—the Data for Health Edition!

Apr 1, 2015• 2

by MICHAEL PAINTER, MD

What if I asked you to talk data—about lots and lots of health data? By that I mean data about you and your community that you and others could use to improve your health.

What if I asked you to sit for hours with others from your community to talk about using the giga-bytes of data from your devices and other sources like electronic health records to help improve health—your health and the health of your community?

Would you play? Would you do that?

Or would you blanch, shake your head incredulous, yawn with boredom and possibly run in the opposite direction?

Well, your colleagues in five cities, Philadelphia, Phoenix, Des Moines, San Francisco and Charleston, SC, played that very game with the Robert Wood Johnson Foundation and members of our Data for Health advisory committee along with the National Coordinator for Health Information Technology and members of her staff.

Boy, did they play.

Last fall in our initiative, Data for Health, the Foundation asked people in those places to spend an entire day talking with us about their hopes, aspirations, worries and concerns with using digital data to improve health.

Honestly, we weren’t at all certain people would play this particular game. We understood—in fact some people told us—that this discussion could seem turgid, distant, maybe even a boring academic hypothetical discussion.

That was not the case.

Turns out it was very easy to draw people into this conversation. People attended and engaged passionately and vigorously. It was a powerful thing to behold.

These people were very interested in using data to improve both their individual as well as their community’s health. Continue reading…

Rooting and Leveraging the Innovation Economy

Mar 31, 2015• 4

by GREGG MASTERS

The use of the term ‘innovation’ is getting pretty worked up lately. In fact, almost every healthcare entity whether health plan, health system, IDN or even ‘mature ACO’ (morphed from an IPA or risk bearing PHO “chassis” or “carcass” as the case may be) seem to have anointed a ‘CIO’ as in ‘chief innovation officer’ to steward the critical transformation from volume-to-value during a yet to be determined period of conflicting if not schizophrenic incentives coupled with its legacy cultural inertia.

In fact some institutions via branded ‘Centers for Innovation or Transformation‘ have made substantial investments in people and infrastructure (“bricks, sticks and platforms”) as well as the promise of the essential ‘firewall inoculation’ and separation from the ‘mother-house’ to catalyze the required re-engineering during a likely period of cannibalization of traditional revenue streams.

So the ancient Chinese curse (paraphrased below) most likely applies here:

..we live in ‘interesting times’ with both ‘danger and opportunity’ before us.

For those tasked with this challenge and fortunate enough to participate in conferences (Health 2.0, Exponential Medicine, Health Datapalooza, TEDMED to name a few of the trophy organizers) at the disruptive and transformational tip of the spear, the nature of the challenge including opportunities to meet and leverage connections of like minded and focus colleagues is a distinct strategic advantage.Continue reading…

Precision Medicine’s First Real Patient: The National Health IT System

Mar 31, 2015• 2

NIAM YARAGHI

In his 2015 State of the Union address President Obama announced the launch of his precision medicine initiative, an audacious initiative to address these issues. In a nutshell, precision medicine customizes health care; That is, medical decisions are tailored based on the individual characteristics of the patients, ranging from their genes to their lifestyle. To have a clear understanding of the relationship between individual characteristics of patients and medical outcomes, it is necessary to collect various types of data from a large population of individuals. The precision medicine initiative requires a longitudinal cohort of one million individuals to provide researchers with various data types including DNA, behavioral data, and electronic health records. Assembling such a large sample of many different data types proposes two unique challenges pertaining to healthcare information technology: interoperability and privacy.

The federal government has already spent $28 billion to incent medical providers to adopt electronic health record (EHR) systems. As a result, almost all of the medical providers in the United States currently compile an electronic archive of their patients’ medical records. However, most of the EHR systems are not able to exchange information with each other. This is a strange problem in the age of information technology and Internet connectivity. There are a variety of technical and economic reasons, which make it especially complicated and difficult to solve.

Given the current lack of interoperability between EHR systems, it seems highly unlikely to be able to obtain a complete medical history of one million Americans. To succeed, the precision medicine initiative has to either overcome the lack of interoperability problem in the nation’s health IT system or to find a way around it. Congress members in both the House and Senate are considering new rules that would stop EHR vendors from interfering with medical providers that had already started transferring records. These efforts are fraught with difficulty and will take a very long time to produce tangible results.Continue reading…

HxRefactored Interview: Care Delivery Innovation with Mulesoft

Mar 30, 2015

Matthew Holt, Co-Chairman of Health 2.0 recently interviewed David Chao, Director of Industry Solutions at Mulesoft. Mulesoft is a “connectivity company” with a vision to connect the world’s data, devices, and applications. During this interview, David shares the challenges within health care and gives an insight into how Mulesoft is re-framing health care delivery and ensuring health data moves freely between multiple systems as well as within organizations to be delivered at the point of care when and where it’s needed the most.

You can see David during the Care Delivery Innovation: Reinventing Access and Expectations session at HxRefactored on April 1-2 in Boston, MA.

What Does Real Meaningful Use of an EHR Look Like?

Mar 30, 2015• 27

By ROB LAMBERTS, MD

I drank the kool-aid early. We installed our first EHR in 1996 with me doing the lion’s share of pushing and pulling. While I’d ultimately turn my back on this passion, I had a number of notable accomplishments before walking down my Damascus road.

Within a year of implementation, our practice became one of the top installations for our vendor.
Within 2 years I was elected to the board of our user group.
Within 4 years I was president.
In 2003, our practice was recognized by HIMSS as one of the top primary care installations of Electronic Records.
In subsequent years I lectured around the country (for HIMSS) extolling the benefits of EHR for both quality and efficiency of care.
As opposed to the experience of other physicians, our practice was not only successful in our implementation, we were in the top 10% in income for our specialty.
Our quality metrics were also routinely far above national norms.
In 2012, I was the physician representative for CDC public health grand rounds, discussing the upcoming EHR incentive program: Meaningful Use.
By 2013, we easily qualified for stage 1 of Meaningful Use, and I happily accepted the financial fruit of my labors.

But the final years were not, as I expected, a triumph. I became increasingly frustrated with the worsening of our EHR by the “features” needed to qualify us for MU1. I also chafed at the way most physicians were meeting this criteria: by abandoning patient-centered care and adopting a data-centered care model. Patients were given useless handouts to summarize “care,” and the data requirement was satisfied. Patient portals gave limited access to information were touted as “patient centered” care, while the product was left unused by most patients, but the data requirement was satisfied.

On Mandatory Screens and the People Doing the Screening

Mar 30, 2015• 2

By ART CAPLAN, MD

The entirely predictable media obsession with the tragedy of the Germanwings jetliner that crashed into the French Alps on March 25 is moving forward full force. The media, especially cable television, love airline disasters. Once German prosecutors revealed that Andreas Lubitz, the pilot at the controls of the Germanwings jetliner when it crashed, had a mental illness but had kept the diagnosis hidden from his employer, all media hell broke loose.

One of the key questions raised by the spectre of mental illness was whether the pilot’s doctors tried to establish Lubitz’s mental fitness to fly and if they were concerned should they have revealed their worries to his employer. Despite a whole lot of talking heads jawing on these points few had anything useful to say since almost none of the experts consulted seemed familiar with the accuracy of mental health screening, or with the nature of German requirements for health screenings for crews or mechanics, or with German privacy law. When the discussion shifted to what about America, things still stayed fuzzy.

Pilots being interviewed noted that the Federal Aviation Administration requires they receive a physical exam from a flight surgeon annually or every six months as they get older. What mechanics or flight attendants undergo was never mentioned. Mental health is supposed to be a part of the exam for pilots but it almost never is. Pilots and the doctors examining them know that any indication of mental illness including addiction or suicidal thinking would get reported right to the FAA and that would be the end of that pilot’s job so little probing gets done. Plus those doing the screening rarely have any training in mental health.Continue reading…

The High Cost of Reducing Waste in US Healthcare

Mar 29, 2015• 69

By SAURABH JHA, MD

Recently, a jury awarded a young California resident $28.2 million for a delayed diagnosis of a pelvic tumor. The jury found Kaiser Permanente (KP) negligent. Doctors in the system, touted to be one of the finest systems by the President, allegedly refused an immediate MRI for back pain in a 17 year old. The patient eventually received an MRI three months after presentation, which found a tumor so extensive that the patient needed an amputation.

The case is instructive at multiple levels. It shows a tense dialectic between the individual and society. It also highlights a truism that many don’t understand or don’t acknowledge – missed/ delayed diagnosis and waste are reciprocal. They’re birds of a feather. You can’t have less of one without more of the other.

The patient presented with back pain. MRI for back pain is the poster child of waste. Why so? Because so many are negative. Even more are meaninglessly positive –disc bulges which simply mean “I’m Homo sapiens and I wasn’t intelligently designed to be sitting at the desk.”

High quality doctors don’t order MRI for back pain immediately, reflexively and incontinently. Think about this. A high quality doctor should say “I don’t think you need an MRI because it won’t change the management and doesn’t improve outcomes.” That’s the resounding message from the top. If it doesn’t improve outcomes it’s not a worthy test. High quality doctors will, once in a while, cost their organization a lot of money.

But quality is still not settled. Quality doctors must satisfy patients. If a patient asks for an MRI for back pain the quality doctor must acquiesce, if that refusal dissatisfies. I’m confused. Ordering an MRI for back pain is poor care. But not ordering an MRI for back pain is poor care. Which is it?

We don’t know the facts of the case. It’s possible that the patient had a neurological deficit that should have raised the urgency. It’s possible that the physician didn’t examine the patient and had he/ she examined, the tumor might have been detected. We don’t know. We shouldn’t judge (1).Continue reading…

Accountable Care: Transparency of Fees Is Mandatory

Mar 28, 2015• 11

By CYNDY NAYER

A personal account of a transaction that went very badly, and rules of Health Reform were not followed.

Accountable Care and associated transparency have not made it to Florida, at least not in this physician’s office.

I made an appt with an ENT (ear nose and throat doctor) for ear wax. When I get there, I need to fill out 5 papers (EMRanyone??), and I’m told there is a $35.00 copay, which she says I can pay on my way out.

The 5 page HIPAA form says they can share my info with other providers who are trying to collect fees. But you only learn this, among other clauses, if you read the form that is tacked on the wall–it’s not in the form the patient signs.

I asked the receptionist how much the office visit is, and she said, “On your insurance there’s a $35.00 copay.” Yes, but is there an additional fee for removal of ear wax? How much? “We can’t tell you that until after the doctor sees you and marks what is done. And besides, we don’t know if you have satisfied your deductible.” I tell her I have not, but because I have to guarantee payment if the insurance company denies anything, I’d like an estimate of charges. She repeats the deductible statement and I say yes, I understand, but that’s a problem, as I haven’t satisfied my deductible so I need to know how much this will be. She tells me she will get the Office Manager (OM).

The Office Mgr (who is disguised in a clinical suit) tells me, “You have to sign this financial form before the doctor sees you because after, you will have received the services so you or the insurance company owe the money.” No problem say I, but I need an estimate, and I can’t sign a financial responsibility form that allows you to bill me if my insurance company doesn’t pay you in 45 days AND that tacks on a 30% interest fee, when I don’t know if I can afford it.

Two visits into the doctor’s lair, she comes out and says, “Dr M is more than willing to provide the services you need but he cannot be interrupted to tell you the costs of the services.” BOOM.