The pMD Blog

Image: Adriana Zehbrauskas for The New York Times

Here's The Latest in Health Care:


• The Centers for Disease Control and Prevention (CDC) released a report this week about a Nevada woman who died because the bacteria was resistant to every single antibiotic available in the United States. Dubbed as a "nightmare bacteria", Carbapenem-resistant Enterobacteriaceae, or CRE, is highly resistant to antibiotics. Recent findings indicate that CRE is more widespread than previously thought and that people may spread the germs even though they may show no sign of illness. Read More

• The number of uninsured Americans will increase by 32 million within a decade by enacting even a partial repeal of the Affordable Care Act. While most of the coverage reductions would result from the disappearance of individual mandate penalties, a mass exit from insurers from the individual market are also expected to play a role. Read More

• A group of prominent donors announced this Wednesday that they had raised almost $500 million for a new partnership with the Coalition for Epidemic Preparedness Innovations to tackle pandemics. New epidemics can be expected to occur regularly and spread quickly due to air travel, public health experts warn. Stopping them in their early stages will save lives and billions of dollars. Read More

• A.I. can be applied today to ever-expanding health data sets. Its many uses can be applied to settings such as clinical decision support, research data mining and analytics, as well as pattern classification for tasks such as tumor detection. One of many limitations to keep in mind, however, is that A.I. is only as good as the quality of data they are being fed. But hospitals holding off on A.I. might be missing out on the opportunity to help shape the technological advancements in health care. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.
As I've worked with several health systems on how they have been handling PQRS reporting and how they intend to report MIPS quality data to CMS, I've seen some things that I can't unsee: the thick binder overflowing with handwritten pages describing various quality measures; the room full of data entry personnel busily reading patient charts; the EHR screens packed with data fields for a physician group that turned on every single outpatient quality measure.

"We'll capture them all up front, then we'll figure out which ones to submit to CMS later," they said. But it turned out that they were having a hard time convincing physicians to go into that EHR screen at all because it was so heinous. Hence the room full of data entry folks.

MIPS is complicated to begin with; and for complicated health systems, it can get REALLY complicated. They have physicians reporting under multiple Tax ID Numbers (TINs), and often many completely different specialties that ended up sharing a single TIN. Assuming they're reporting as a group (GPRO), that means they often pick "lowest common denominator" measures centered around primary care. This burdens their already-overworked Primary Care Providers with additional data entry, and it effectively excludes many hospitalists, surgeons, and other specialists from quality reporting - certainly from any quality metrics that matter to them.

But with ever-increasing risk from mandatory bundled payments, Accountable Care Organizations and other advanced payment models, and the upcoming cost component of MIPS, I'm hearing from more and more of these enterprises that they can no longer afford to make quality something that only the Primary Care Providers and care coordinators worry about. It's something that involves the specialists too - for example, if a hospitalist fails to talk with a patient about their advance care planning, that patient could end up receiving a very costly and unpleasant intervention that perhaps they didn't want. Getting buy-in from the specialists, and giving them a way to measure their success on these metrics, is vital.

Thinking back to the room full of data entry specialists reading charts, I'm struck by the gap between the ostensible intention of these quality programs (improve the quality of care by rewarding physicians who follow evidence-based care) versus their result (the physicians are not engaged, and the hospital suffers additional costs to hire a room full of people to read their charts and enter data into a registry). There is a better way to engage specialists in quality programs and to actually improve outcomes in the process, but it has to meet them where they are - which is not necessarily sitting in front of a computer - and it has to offer them targeted measures that are relevant to their specialty, not just smoking cessation.

At pMD, we say: bring it on! We love working with specialists of all kinds, and we've developed some innovative tools that help with measure selection and targeted mobile data capture during hospital rounds and immediately after surgeries. There is no one-size-fits-all solution for MIPS, but the future is bright for organizations that embrace their own complexity and find a nuanced solution that will work for them and their physicians.

Image: Getty Images

Here's The Latest in Health Care:


• In a recent analysis released this week by the nonprofit Fair Health, studies have shown a sharp rise in obesity-linked diagnosis among kids and teens. These findings come amidst a rise in obesity-related insurance claims for youth under the age of 22. Whatever the underlying cause of the increase, one thing remains certain: the longer children remain obese, the more likely they are to get diabetes. The challenge is providing the resources that will be necessary to address this emerging situation. Read More

•  The ongoing Affordable Care Act (ACA) debate continues as Republicans push forward with a repeal. Lawmakers have cautioned about moving too quickly and some even Republicans have asked to delay repeal of the ACA until a replacement plan is in place. However, after seven hours of voting this Thursday and objections from Democrats, a budget that could possibly dismantle the ACA received the needed simple majority, 51-48, to pass the Senate. Read More

•  Recent observational studies have found that "weekend warriors", or individuals who pack in their workouts into one or two sessions over the weekend, are equally less likely to die prematurely as individuals who meet the recommended guidelines of five moderate 30-minute sessions each week. But don't get too comfy on the weekdays. There are still a lot more health benefits to spreading out your exercise throughout the week! Read More

• A new study recently published by Health Affairs has found that hospitals affiliated with accountable care organizations (ACOs) were able to reduce readmission rates of nursing home patients in contrast to other hospitals. What exactly are ACOs doing differently to improve readmission rates? Researchers are calling for additional studies to examine the discharge behaviors and care coordination of ACO-affiliated hospitals to determine their impact on these statistics. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.
As a software engineer at pMD, I get to straddle the cutting edges of two very different industries: health care and technology. I’m familiar with how quickly the technology world moves -- developers jumping on a new front-end technology every other day, “sprinting” through “agile” hoops at the speed of light. But I’ve been surprised to learn how thoroughly the health care environment is also evolving. I’ve learned that over the next few years, physicians will be facing fundamental changes in the way they see and treat patients. It has been one of the most interesting parts of my job to not only learn about these changes, but to help providers transition to the health care environment as it transforms around them.

With value-based health care on the horizon, providers will need to bring the patient into the center of their care. For the more than 100 million Americans with chronic illnesses, for example, the occasional face-to-face encounter with a provider might not be enough. Obviously, for those types of patients, providers must think beyond the 30 minute annual checkup; with constant management of medication, treatment, and services. In today’s day and age, providers often have difficulty bridging communication gaps, leading to inconsistent data, increased expenses, and poorer outcomes for their chronically ill patients.

We are trying to solve that problem at pMD, and to help providers proactively coordinate their patients’ care. Every new feature we are working on supports providers as they take on this new paradigm shift. One of the simplest ways we help providers is by showing them how they can get reimbursed for adapting to this new, patient-centric health care model. For example, since 2015, Medicare has reimbursed providers who offer at least 20 minutes a month of non-face-to-face medical care to patients with two or more chronic diagnoses, through CPT code 99490. For our providers -- who have been using pMD's charge capture tool to record services outside of face-to-face encounters like medication reconciliation review and care coordination, and may soon start to use pMD for patient education -- this could prove to be a fruitful change that helps them transition to tomorrow’s health care system.

Image: Getty Images

Here's The Latest in Health Care:


• SBH Health System, based in New York’s Bronx borough, is taking a different approach to addressing its community’s health care needs.  The organization is working with a developer to build low-income housing on its campus, which includes urgent care and outpatient options, in an effort to reduce hospital admissions. Offering housing options can have a significant impact on low-income patients by allowing them to manage their health and access much needed care. Read More

• The National Institutes of Health (NIH) announced this week that the recommended time frame in which parents should introduce peanut-containing foods into babies’ diets can start as early as 4 to 6 months, with proper evaluation by a specialist prior to doing so. Many studies in the past few years have found that babies with a high risk of developing a peanut allergy are less likely to develop the allergy if regularly exposed to peanut-containing foods in their first year. Read More

• Due to a recent change in New York state policy, providers are now able to access patient data for minors through state-qualified exchange entities, with the consent of the child’s parents or legal guardians. For minors who may see several specialists, this change gives parents and legal guardians the peace of mind that their child’s care team will have access to the most up-to-date health information. Read More

• Think you’ve ever had a bad reaction to five-too-many gin and tonics? Hangover central? Try being one of the rare individuals who are allergic to quinine, a malaria treatment used for hundreds of years and, more recently, the ingredient that gives tonic water its bitter tang. Individuals who are allergic to quinine can react violently, becoming ill with chills, fever, vomiting, headaches, or additional side effects, and may even experience lingering kidney and cognitive problems. But don’t worry, tonic lovers. The condition is rare and very few people have to worry about it. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.

For many practices, PQRS is a four-letter word. PQRS, or Physician Quality Reporting System, is a federal program that requires the large majority of medical practitioners to submit data annually on their patient encounters. If they fail to do so, they get dinged on their Medicare reimbursements. The program is intended to standardize the quality of health care across the country, but it’s also causing many headaches and sleepless nights for medical practices along the way. PQRS isn't going away, either. In fact, it has more or less been renamed "Quality" measures under the MIPS program starting this year.

Practices who are eligible for PQRS reporting have a couple of options for reporting their data, depending on their Medicare volume and what kind of data they have (or haven’t) captured in 2016. And for practices that haven’t started yet, it’s not too late. Some PQRS registries will allow you to submit your data as late as February 28.

Measures Groups reporting allows practices to submit data on just 20 patients per provider, and not all of those patients have to be Medicare! You must select one of CMS’ approved groups, such as Diabetes, Heart Failure, Preventative Care, Oncology, and more. These groups include a specific set of applicable measures you will need to report on.

Individual Measures allows practices to choose 9 measures to report on, but they must report these measures for at least 50% of their qualifying Medicare patients in 2016. Practices who see a high volume of Medicare patients can expect to report on a much larger set of patients if they choose to report individual measures. GPRO practices will report on 50% of their group’s patients versus individually by provider.

If you have been capturing PQRS data throughout the year on your Medicare patients, then you’re doing well and the manual data entry at the end of the year should be minimal. And if you haven’t been thinking about PQRS until now for fear it may give you more gray hairs, then you’ve come to the right place. It’s important to work with a registry that will work collaboratively with you to choose the best reporting plan for your group. pMD allows you to upload your patient and billing data, view your progress in a user-friendly dashboard, and easily update or add any additional data. Contact us to learn more at 415-422-9578.

Image: Phil Marden

Here's The Latest in Health Care:


• This week, the Food and Drug Administration (FDA) finalized guidance on how to protect medical devices from cyber attacks. It outlines how manufacturers should maintain security for medical devices that are connected to the internet but these guidelines come with criticism as there is no final draft on how to enforce these rules. Read More

• The new year is fast approaching and as resolutions gear towards a healthier year, consider a gut makeover by investing in the long-term health of your microbiome (bacterial and microbial community living in your intestinal tract). This microbiome allows us to properly process nutrients from our food, along with many additional health-promoting tasks in our body. Altering our daily diet to more plant-based foods and restricting daily calories in comparison to a typical American diet are just some of the ways to a healthier gut in the new year! Read More

• As we say goodbye to 2016, we look back on some incredible headlines that mark this historical year. One such story, much to the dismay of health care IT, highlights the upward and increasing trend of security breaches in electronic health records. In October of this year, more than 25 million patient records were reportedly compromised and even more leading into the end of November, half of which were a result of inside employees. Will we see stricter enforcement on electronic actions in 2017? Read More

• In some counties across the U.S., Obamacare consumers will only have one, single insurer to choose from. While there is an expectation to see price hikes in areas without insurer competition, the reality is that prices for underserved areas are not significantly higher than they are for people living in areas served by multiple insurers, according to data from Avalere Health. The reason could be attributed to the fact that insurers had to file their initial 2017 rates prior to knowing exactly where competitors were dropping out. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.

Image: Samuel Aranda for The New York Times

Here's The Latest in Health Care:


• A new, experimental Ebola vaccine has been shown to provide 100 percent protection against the lethal disease. The 2014 Ebola outbreak, primarily in Africa, killed 11,000 people and reached many countries overseas. While this new vaccine has not yet been approved by any regulatory authority, it has been considered so effective that 300,000 doses have already been created. Read More

• Health IT organizations are asking the Centers for Medicare and Medicaid Services (CMS) for more time regarding the implementation of MACRA. Some major concerns focus on the preparation time of both vendors and providers, needing ample time for development, testing and deployment of software programs to satisfy CMS' requirements. Read More

• With the rampant spread of antibiotic-resistant germs, the government has decided to cut payments to hospitals with high rates of patient injuries due to this cause, including potentially avoidable complications such as various infection types, blood clots, bed sores and falls.Based on rates of these complications, hospitals can lose 1 percent of all Medicare payments for a year beginning this past October.  Read More

• This week, the Office of the National Coordinator for IT (ONC) released its Interoperability Standards Advisory for 2017. It includes essential standards and implementation specifications for tech developers and clinicians. These specifications are meant to further the spread of interoperability and enable ease of sharing with regards to clinical data. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.

Image: FierceHealth.com

Here's The Latest in Health Care:


• In the past five years, deaths due to hospital-acquired conditions have shown a significant decrease. This, in turn, has saved hospitals more than $28 billion in health care costs, according to a new government report. A big factor in the decline is being attributed to the Affordable Care Act and how its tools and resources to build a better health care system resulted in the best possible outcome for the patient.  Read More

• In the last few weeks, at least five cases of the Zika virus transmitted by mosquitoes have been reported in Brownsville, Texas. On Wednesday, the Centers for Disease Control and Prevention warned pregnant women to avoid the area due to the threat of infection.  Read More

• Patients are frustrated with the lack of a centralized health record, coupled with the inaccessibility and difficulty to share their own personal health information with other providers, according to a new survey from health information network Surescripts. Patients are typically spending an average of 8 minutes telling their doctor their medical history. If health data were stored electronically in a single location, doctors could see an improvement in efficiency and a reduction in medication errors. Read More

• Cuisinart, a popular kitchen appliance brand, is voluntarily recalling about 8 million units after it was found that 30 cases of broken blade pieces found in food had caused mouth lacerations and tooth injuries. The units were sold from July 1996 through December 2015, according to the company, and customers can get a free replacement blade. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.
To run a health care practice, it’s crucial to have the right information to navigate through the many government changes. So I’ve put together a MIPS For Dummies, of sorts. My goal is to give you some insight into the quickly approaching government changes to the reimbursement process. The Centers for Medicare & Medicaid Services (CMS) has released some preliminary information and here is what we know.

Let’s start with the basics. What does MIPS stand for?
Monkey-Identified Petite Scoliosis. Just kidding! MIPS is the Merit-Based Incentive Payment System and it is a new value-based payment model. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the statute that created this new advancement of the value-based payment model.

What is MIPS?
MIPS is a new payment system outlining financial incentives (and penalties) based on the data submitted by practices, which judges the quality, outcomes, and efficiency of patient treatment. Imagine that the Value-Based Modifier Program, Physician Quality Reporting System (PQRS), and the Medicare Electronic Health Record (EHR) all met and joined forces under one larger, combined program.

Who is at the mercy of MIPS?
Perhaps you, if you’re reading this blog post. But really, MIPS reporting will be required for any clinician billing for professional services under Medicare Part B. This includes all physicians, dentists, chiropractors, physician assistants, physical or speech therapists, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and hospital-based eligible providers. Providers who are in their first year of Medicare or are below the low-volume threshold may not be required to participate in MIPS.

When is MIPS currently scheduled to roll out?
January 1, 2017! This time I’m not kidding…

Finally, here are some fun facts about MIPS:
1. Centers for Medicare & Medicaid Services (CMS) is no longer accepting comments on the proposed rule - The cut off date was June 27, 2016. However, the final rule with comment period was issued on 11/4/16, and you can comment on that for only a few more days! Cut off for the comment period for this version of the rule is 12/19/16.

2. Qualifying Advanced Alternative Payment Model (APM) Participants are eligible clinicians who are exempt from the MIPS model. This includes Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models.

3. CMS released a fancy new (and surprisingly helpful!) website that guides practices through how to participate in each category of MIPS.

4. To participate in the ACI portion of MIPS you will need a 2014 or 2015 Edition Certified EHR before or on January 1, 2017.

5. If you're eligible for MIPS but decide not to participate in the program, you will receive an automatic negative 4% payment adjustment on your 2018 Medicare reimbursements. (This one is a not-so-fun fact).

Now, last but not least, pMD’s web portal can produce reports reflecting valuable quality data that can be leveraged for MIPS reporting, PQRS solutions and other government changes.

#MIPTASTIC #MIPSYALL #MIPSYEAH