The pMD Blog

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pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.


Image: iStock

Here's The Latest in Health Care:


•  Consumers who are hunting for health insurance during the open enrollment period are either finding prices to be more expensive or are finding cheap deals, depending on subsidy eligibility for 2018. For those who are eligible for subsidies, insurance brokers and analysts are cautioning clients against the temptation to get the inexpensive plans that don't comply with the Affordable Care Act's minimum standards. Some states have extended their open enrollment period past December 15.  Read More

•  The office of the National Coordination for Health IT (ONC) recently published best practices for data management processes, enabling hospitals to more accurately and effectively match patient records.  There are 5 categories published in the Patient Demographic Data Quality Framework across which hospitals can begin to evaluate their own organizations: Data governance, data quality, data operations, platforms and standards, and supporting processes.  Read More

•  In a new study released by the Journal of the American Medical Association, intense treadmill exercise has been found to be safe for those recently diagnosed with Parkinson's disease and may even slow the progression of their condition in the early stages of the disease. Current methods of treatment involve various drugs, most of which lose their effectiveness over time. While more studies have yet to be done, the findings are encouraging.  Read More

•  On Thursday, the Federal Communications Commission (FCC) voted in favor to repeal net neutrality regulations. How does this impact telehealth? The new regulatory environment could break telehealth and remote monitoring functionality for providers, patients and vendors, especially those in rural areas of the country. Connectivity is an essential element of telehealth and without it, it doesn't work. Higher prices for connectivity might force providers in rural areas to abandon telehealth programs all together.  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. Brought to you by pMD, innovators in charge capture software.


Throughout pMD’s nearly 20 years of existence, we have always been extremely proud of our unparalleled customer service. Our commitment to providing great service is one of the first things potential new clients come to learn about pMD, either from reading the hundreds of testimonials housed on our public website, word-of-mouth, or in initial conversations with a member of our sales team.

We all know it’s easy to say our customer support is “unparalleled,” but what does that actually mean? As part of the customer success team here at pMD, I’m prepared to put my money where my mouth is on this one! Below, are just a few of the things that make the support we provide so excellent.

1. Easy to Reach: Users can get in touch with us extremely easily. They can call or message support directly from pMD’s mobile application or from our website. There are no hoops they have to jump through to discourage them from reaching out, and they always speak directly with a live pMD employee. Plus, because the medical world doesn’t close up at 5pm, neither do we - pMD support is available 24/7/365.

2. Timeliness: Our goal is never to miss a phone call and to reply to all written correspondence within the same business day, at the latest. Our software is designed to be used in real time, and we want our support model to be responsive to users who need help as they’re using our products throughout the day.

3. Product Knowledge: Learning how to provide a high level of service to our customers starts on day one of new employee training, and throughout an employee’s career at pMD, they maintain responsibility for helping with customer support. All of our support comes from in-house and is never outsourced to a third party or contractor.

4. Good Judgement: More often than not, questions or issues that come to us via customer support truly are support items, such as a user who forgot their username or a new employee who needs access. However, sometimes an inquiry that initially is posed as a support item is really part of a larger project or requires training or workflow updates affecting many users. If that’s the case, that client’s account manager is notified and included in the conversation so that they can assist with resolution for longer-term or more complex undertakings.

Our vision is that getting in touch with pMD’s customer service is just as easy as using our charge capture, secure messaging, care communities, and quality reporting software. A quick and easy resolution means that medical providers and their staff can get right back to doing what’s most important - treating their patients and saving lives!

If you'd like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

Image: Joy Ho for NPR

Here's The Latest in Health Care:


•  On Monday, Google announced an open source version of their artificial intelligence (AI) tool, DeepVariant. This tool improves the accuracy of genomic sequencing, which addresses one of precision medicine's outstanding challenges. Big tech rivals, such as IBM, Microsoft, Apple, and Amazon are already speculated to be making moves into the health care AI space.  Read More

•  A recent study revealed that women who use hormonal birth control pills or contraceptive devices such as intrauterine contraceptive devices (IUDs) face a small yet significant risk for breast cancer. This is the first study to examine risks associated with current, modern forms of birth control in a large population, however, not the first to establish a link to cancer.  Read More

•  Health care spending in 2016 saw a slow in growth, likely due to an increase in insurance enrollment during the first few years of the Affordable Care Act (ACA).  According to the Centers for Medicare & Medicaid Services, per capita spending topped $10,000 in 2016 and spending per person was $10,348. Experts expect a continuation of growth in health care spending due to an aging population and growing health care costs.  Read More

•  Common ceramic household cookware, such as crockpots, may contain traces of lead, which can leak into food and cause lead poisoning. Where does the lead come from? Ceramic ware is glazed before entering a kiln to bake. Often, these glazes contain lead, which gives ceramic ware their attractive shine. Be sure to refer to the FDA's list of products that have been tested for lead contamination!  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. Brought to you by pMD, innovators in charge capture software.


When you think of traditional sales, you might think of someone dressed in a suit talking at you and trying to persuade you of why you need their product right at this moment. When I joined pMD’s sales team, I thought about all the new tea flavors I would need to check out to prep my voice for all the talking I’d be doing while selling our products. Because I was joining pMD’s sales team with little previous sales experience, all I had to base my expectations off of were the Hollywood stereotypes of sales. I thought I would be informing people of why they needed our products. Unexpected to me, in the first few months of learning and leading my own sales, I found myself doing a lot more listening than talking. It was very different from what I had anticipated, but I quickly learned that if I did all the talking, there was a lot I’d be missing out on when learning about a customer.

pMD isn’t a one-size-fits-all product. If you work with us, you will quickly find out how focused we are on details and understanding processes. This begins in the sales process and goes all the way through to the implementation and account management stages. pMD employees are always open to listen and to hear how we can make our product work for you.

While we do wear business suits, our sales process differs from the Hollywood stereotype I thought it might be. When talking to a new group, I’m not able to tell them about what pMD can do for them until I take the time to learn about what inefficiencies and issues they’re experiencing in their current process - essentially the “why” they reached out to pMD in the first place. For example, during our charge capture sales process we spend a lot of time learning about how a group is currently keeping track of their billing charges and what areas pMD can assist to make the process more streamlined and efficient. You would think this information could be answered by asking a question or two and then answered in no more than three sentences. Oh no. We are not looking to hear the brief answer. We want to hear all the nitty gritty details. What is a provider's current workflow? What is really frustrating about their current system of collecting and submitting charges? In which areas would they like more transparency? What analytics are they hoping to track? We listen so closely and push for details to uncover the best way to improve a group’s workflow and make sure their account is set up so pMD is easy to use, efficient, and successful.

I recently implemented a customer on pMD's Charge Capture product who was solely using a paper process. During each of the many conversations I had with the group during the sales and implementation process, I learned something new every time from the providers or administrative team regarding difficulties in their current workflow that they were experiencing. Because I came to know their current process so well, we were able to customize pMD for them in a way that helped improve many of those kinks. Listening for key phrases like “it is difficult to track…” or “I find it hard to…” are triggers in my mind to get me thinking about customizations that would help make their process easier. There is something rewarding in having the ability to talk to a group and continue learning about them through each conversation along with what customizations could make their pMD experience more useful and easy to use. At the completion of the group’s implementation, these customizations allowed for better organization and reporting for everyone involved. It felt great to uncover some areas they didn’t even know could be improved!

I’ve come to learn and see first-hand the benefits of taking the time to really listen and uncover the needs of our customers. Customization is something pMD prides itself on and something we are always happy to discuss with any current or soon-to-be customer. If you'd like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

Image: Paul Rogers

Here's The Latest in Health Care:


•  Health care tech vendors are creating products specifically geared towards use for accountable care organizations, or ACOs. With the industry transitioning to more value-based care and payment reform, ACOs need robust analytics and advanced care management platforms that perform beyond what today's EHRs are capable of doing.  Read More

•  The Mental Health Parity and Addiction Equity Act, passed in 2008, promised to make mental health and substance abuse treatment easily accessible as the treatments that are available for any other condition. However, a recent national study found that health insurers are skimping out on mental health coverage and patients are still struggling to gain access to affordable treatment.  Read More

•  This morning, the Centers for Medicare & Medicaid Services (CMS) announced it has officially canceled mandatory cardiac and hip fracture bundled payment models. While CMS sees this as a way to offer hospitals greater flexibility and choice in how they provide care to their Medicare patients, some health care experts believe this might hurt the value-based care movement.  Read More

•  Do you think you're all caught up with the latest health care news? Take this week's quiz to see how much of that information you've retained!  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. Brought to you by pMD, innovators in charge capture software.

Health care practices are very active in a wide variety of reporting and often times report to various different organizations in order to track population health, positive outcomes, and quality of care. Some of these reporting mechanisms are hosted by government agencies, highly-regarded news sources, specialty councils, and national organizations. One such type of reporting is through a Clinical Data Registry. These type of registries are made up of similar medical practices and specialties to gain a better understanding of the care given to patients. This also allows groups to benchmark their organization against other participating groups. These registries collect information on the specified health care population and utilize the information to track trends in how disease is managed and how it is progressing within a population.

Why Participate in a Registry?

Participation in a registry allows organizations to gain additional benchmarking and provides access to best practices when looking to improve clinical outcomes and decrease cost. Through this registry data and research, clinicians and scientists will be able to establish patterns based on disease progression, current medical standards, and patient outcomes to determine and share best practices within a community of similar health care organizations. The hope is that this invaluable insight will progress beyond a zip code and expand into the big picture of national and global health care.

Here are just a few of the many registries to choose from:

US Wound Registry
National Palliative Care Registry
National Radiology Data Registry
Lung Cancer Screening Registry
National Cardiovascular Data Registry

Tracking and Reviewing Registry Data

Tracking data, compiling answers to survey questions, and reporting to an organization may sound a lot like incentive-based programs such as MIPS reporting. While participation of these programs are required by the government, reporting to clinical data registries is completely optional and benefit the group of health care organizations that participate by allowing them to see where they stack up against their peers. While these registries may vary in reporting mechanisms, the format of reporting is generally the same. Typically, there is an annual survey that would need to be completed, which always includes the requested data points. Health care organizations will review various metrics that are both clinical and care-based such as readmission rates, standards of care, diagnosis at the time of consult, patient engagement, etc. from the previous year and submit that data to the registry. This may require a need to do an in-depth review of clinical care, social work, and assessment of everyone who is part of the patient’s care team to get an accurate depiction of what is involved with caring for these populations.

How Can pMD Help?

Combing through a full year’s worth of data across multiple teams can be daunting, requires a considerable investment of time, and may leave you thinking, “There has got to be a better way!” Here at pMD, we are working with health care organizations who are at the forefront of population health and participate in these registries. We work closely with physician teams to capture more than just billing information but also additional clinical and pertinent information as well.  pMD has been well-established in working with physicians for tracking this type of information.

Now, with the use of our care coordination product, we are able to assist care coordinators and social workers with securely communicating with patients and their physicians and capture valuable information that would otherwise be lost in the sea of notes come time for reporting.

If you or your organization would like to hear more about what we are working on here at pMD, including our MIPS registry, charge capture, secure messaging, and care coordination software and services, or what we can do to help you achieve your goals, we invite you to reach out to us.

Image: Andy Baker/Ikon Images/Getty Images

Here's The Latest in Health Care:


•  Doctors are now allowed to prescribe addiction medication virtually, after the President declared the opioid crisis a health emergency. However, some health care professionals are skeptical. The in-person visits establish trust and allow physicians to pick up on things like body language that are often hard to determine through a screen.  Read More

•  The health care industry is a buzz with rumors that big tech giants like Apple and Amazon are poised to enter the EHR market. Apple is rumored to be working on putting health records on the iPhone, making it easy for users to access their own medical records. Amazon has started a secret lab to explore business prospects in the health care sector.  Read More

•  The Centers for Medicare and Medicaid Services proposed a new rule last week for Medicare Advantage, Part D. The proposed rule would make several changes aimed at reducing regulatory burden for plans and promoting flexibility when it comes to Medicare Advantage.  Read More

•  The presence of abnormal proteins, or prions, in the skin samples of those diagnosed with Creutzfeldt-Jakob disease, a rare brain-destroying disease, may be used to improve detection of the disorder. Currently, the disease is diagnosed using more invasive procedures such as brain biopsies or autopsies.  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. Brought to you by pMD, innovators in charge capture software.

Alright alright alright! We made it to Part 4. Phew!!! As hopefully you know by now, in Part 1 of this series, we discussed the Basics of MIPS Scoring, and in Part 2, we discussed scoring for the Quality category. In Part 3, we discussed Improvement Activities scoring. Today, in our big series finale, Part 4, we’ll cover Advancing Care Information (ACI) scoring, plus an overview of the MIPS final score and payment adjustment calculation. And, away we go!

The Basics of Scoring the Advancing Care Information Category

One note before we hop into the weeds of scoring ACI. There are many exceptions to reporting ACI, so be sure to investigate those in case one applies to you or your group. The ACI exceptions are sometimes also called “ACI reweighting” because your overall score will be reweighted if one of those exceptions applies. See page three of this guide for a good resource to learn more. But, for the purposes of this post, let’s assume that you are required to report the ACI category and therefore, your MIPS score has not been reweighted.

Your overall ACI score has three parts, and each part is weighted differently. We have:

1. The base score, which is weighted at 50% of your total ACI score;
2.The performance score, which is weighted up to 90% of your total ACI score; and,
3.The bonus score, which is weighted up to 15% of your total ACI score.

If combining your scores in each of these parts results in a score higher than 100 points, you’ll automatically get full credit for the ACI category of MIPS. Now let’s look at each part in turn.

ACI Base Score: Required, and Worth 50% of Your Total ACI Score

In order to earn any points for the ACI category, you must successfully report the base score measures. But, luckily, successfully reporting the base score measures is relatively straightforward. To do so, you must:

1. Submit a “yes” answer for the security risk analysis measure; and
2. Submit at least a “1” in the numerator and denominator for the rest of the base score measures, indicating that you completed that measure at least once during the reporting period.  

The base score measures consist of either 4 or 5 measures, depending on what edition your electronic health record (EHR) is. To find out which EHR edition you use, visit here and then here. Depending on your EHR edition, here are the two separate sets of measures that you can report on:


Again, as long as you submit a yes to the security risk analysis measure, and at least 1 for the numerator and denominator for each other measure in your applicable base measure set, then you’ll get the full base score points. Easy, right? Let’s look at the performance score.

ACI Performance Score: Optional, but Worth Up to 90%

For the performance score part of ACI, you can choose the number of measures to report, with the maximum number dependent on the measure set you are reporting. Your measure set choice will be the same as it was for the base score, so no need to re-determine that for the performance score. Here are the two measure set reporting options, with corresponding measures:


For most measures, you will report a number for both a numerator and a denominator. With some nuance, the denominator is the number of times your practice could have performed a certain act, and the numerator is the number of times your practice actually did perform that act.  A performance rate is then calculated for each measure, based on the numerator and denominator. That performance rate is used to determine how many points you will receive for each measure, with most measures being worth 10% of the performance score (see above chart for each measure’s worth). The better your performance rate, the higher your score, as illustrated here:


Add up each of the points from these measures, and you’ll have your performance score for the ACI category.

ACI Bonus Score: Optional, and Worth Up to 15%

Last but not least, we’ve got the ACI bonus score. There are two ways you can earn bonus score points:

1. Indicating “yes” to reporting to public health and clinical data registries beyond the immunization registry reporting measure. Doing so earns you a 5% bonus.
2. Indicating “yes” that you completed 1 of your improvement activities using certified EHR technology. Doing so earns you a 10% bonus.

If you complete either one of these activities, you will receive bonus points for your bonus points score.

Each of these individual scores is then added up to get your total ACI score. As mentioned above, if each part of your score adds up to more than 100%, you’ll automatically get full credit for the ACI category, which is worth 25% of your overall MIPS score.

The Final Score and Payment Adjustment

Ok, the finish line is in sight!! We’ve reviewed scoring for each of 2017’s weighted MIPS categories, so now let’s take a look at how all that comes together to determine the  most important factor: your payment adjustment.

Once CMS determines your score from each of the categories, each score is then weighted accordingly, then added up and multiplied by 100 to get a your final score, which will be between 0 and 100.


Your score then corresponds to your payment adjustment, along the following scale:


The amount of the payment adjustment itself will depend on how other eligible clinicians perform because the amount of the payment adjustment is scaled. But, if you do exceptionally well - aka higher than 70 points - you can receive an exceptional performance bonus, in addition to the standard bonus. The amount of the exceptional bonus will also depend on how many other eligible clinicians score about 70 points.

And that, ladies and gentlemen, is IT! That is how CMS will calculate you MIPS score and corresponding payment adjustment. Easy, right? Well, if not easy, I hope, at this point, MIPS scoring is at least clearer than mud. But, if it isn’t - or if you are interested in learning more about pMD’s suite of products which includes MIPS Registry, charge capture, secure messaging, and care coordination software and services - please contact pMD. We’d love to hear from you!

References:

Quality Payment Program Merit-based Incentive Program (MIPS) Scoring Guide 101 for the 2017 Performance Period, available at https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/MIPS-Scoring-101-Guide.pdf

Advancing Care Information Measure Specifications, available for download in a zip file at https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/Resource-library.html.


Image: Proteus Digital Health

Here's The Latest in Health Care:


•  Who will be replacing Tom Price as the next Secretary of Health and Human Services (HHS)? Alex Azar, former pharmaceutical executive at Eli Lilly and former HHS general counsel and deputy secretary, is the President's nomination for the next head of HHS. Some major goals Azar will be tasked with, if confirmed, is the lowering of drug prices and implementing deregulation.  Read More

•  The Food and Drug Administration (FDA) has approved the first drug with a sensor that transmits data to a smartphone app, notifying whether someone has taken it. The tiny sensor is about the size of a grain of sand and is embedded into the pill, serving as a digital ingestion tracking system.  The sensor will detect and record the date and time the pill was ingested.  Read More

•  In the first 11 days of Healthcare.gov's open enrollment period, signups totaled nearly 1.5 million. Some experts suggest that with the push for the Affordable Care Act (ACA) repeal, the heightened visibility of the health care law is actually driving the increase in signups for the ACA exchange plans.  Read More

•  Scientists have found that a rare genetic mutation in Amish people living in a rural part of Indiana actually protects them from Type 2 diabetes and provides life-extending benefits.  The new findings could lead to new therapies for chronic diseases.  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. Brought to you by pMD, innovators in charge capture software.

I recently celebrated my 10-year anniversary at pMD. 10 years at the same company is becoming a rarity in the software industry. Yet my dad, Dan Kenney, worked for 40 years for the same architecture firm. 40 years! It sounds like an old-timey tale, a story about the Company Man. I began to wonder what about his company could have possibly held his attention for so long - it must have been quite an amazing institution.

But many others at his company came and went over the years, so maybe it was him rather than the company itself. Did he lack imagination? He’d been very successful and could have retired earlier, yet he kept chugging away and taking on greater responsibilities. I think he was genuinely happy there, and he didn’t feel a need or desire to move.

I began to wonder if the anomaly is not him or his company, but rather the software industry. It began to seem strange that Amazon has a 1-year median tenure and Google has a 1.1-year median tenure, both in the bottom 5 of the Fortune 500 according to PayScale for this measurement. If these companies are admired and successful, why aren’t their employees sticking around?

There are many good reasons to leave a company. The top reason given is greater opportunity for career advancement elsewhere. In other words, there is a lack of mentorship and growth at the old company. Now, the same companies that failed to offer in-place growth opportunities are adapting to their job-hopping employees:

"Hiring managers worry they’ll become the next victims of these applicants' hit-and-run job holding. For companies, losing an employee after a year means wasting precious time and resources on training & development, only to lose the employee before that investment pays off.” - Jeanne Meister, Forbes


But by reducing training and mentorship, wouldn’t they further decrease the opportunity for in-place career growth? They aren't expecting employees to stay around for a long time, so they’re not investing in their people, instead focusing on making their jobs more specific and interchangeable - like a “code factory” where a new assembly line worker can easily be slotted into a vacant position.

I don’t know whether companies or employees started this vicious cycle, and perhaps it makes sense in an increasingly commoditized industry that is dominated by a few huge near-monopolies. And I’ve met my share of counter-examples even at these companies, “lifers” who have stuck around for a long time and have no intention to leave. So there’s a ray of hope: if the fit is right, and the position has room to grow, then career bliss can still occur - even in today’s bleak landscape. So then, how to find the right long-term fit for you?

While researching this question, I found many different answers. A romantic advice blog said it best:

“When you know what you want, everything else becomes trivial. The better you understand yourself, the more experience you have and the clearer the life you want becomes. When we learn more and more about ourselves throughout our lifetimes, we come to a point of clarity. We come to a point at which we know what we want, and we know what we have to do to get it.”


I think self-knowledge was the key to my dad’s 40-year happy place. He knew what he wanted to achieve in his career and what kind of culture he needed to be successful, and he worked ceaselessly towards both. He didn’t bail when times got tough because he knew what he wanted, and he knew that his company was the right place where he could forge that vision into reality regardless of any setbacks along the way.


Dan Kenney

Self-knowledge sounds great. If only they sold it on Amazon! Some people seem to be “old souls,” born with more of it. Unfortunately for the rest of us, it’s generally hard-won. Most people gain self-knowledge by making mistakes and learning from those mistakes. Indeed, embracing failure is the approach most commonly recommended in tech. This is a very effective way to learn, but not a very efficient way because there are so many possible mistakes. Even if you learn from each mistake that you make, there are countless other varieties just around the next corner lying in wait for you. You’ll never live long enough to make all the mistakes.

Fortunately, you can also gain self-knowledge in other ways. You can ask experienced and successful people for advice, or read books written by wise people, and benefit from their mistakes without having to make the same mistakes yourself. You can pursue meditation or counseling to gain greater awareness of your own biases, blind spots, and true desires.

For example, would you enjoy the rollercoaster ride of a high-risk company such as an early-stage startup, or would you prefer the sanity and routine of a company that’s been around for a while? Would you appreciate the well-defined, relatively narrow expectations of a career at a large company, or would you prefer the freedom, flexibility, and variety of a small company? Is it most important to you to feel protected and cared for by a high-comfort company, or are you happiest when making sacrifices for the good of others at a high-service company such as a nonprofit?

In the end, it’s all about what you want and what makes you happy and satisfied. If you know what your sweet spot would look like and you put all your energy into finding or creating it, then all the other decisions along the way become trivial and you’re on your way to the mythical 40-year, same-company career. I hope to see you there!

Interested in joining the pMD team? Check out pMD's careers page for more information! To find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.