The pMD Blog

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Here's The Latest in Health Care:

•  President Trump's nomination for mental health "czar", Elinore F. McCance-Katz, exposes a longstanding rift in an already divided field. Supporters of Trump's nominee back the use of drug and hospital treatments, a stark contrast to the psychosocial end of the spectrum, which puts more emphasis on family and peer support as well as community care.  Read More

•  Two pharmacists from New York Presbyterian Hospital have teamed up with the hospital to consult with transplant patients virtually, tapping into telehealth to improve care for these specific subset of patients. This approach allows them to continue care after the patients' hospital discharge.  Read More

•  A rare outbreak of botulism has been linked to nacho cheese sauce bought at a gas station in Walnut Grove, California, killing one man and hospitalizing nine others. Botulism is rare, with only 20 cases in adults each year, according to the Centers for Disease Control and Prevention. After health officials removed the nacho cheese sauce from the gas station on May 5, the California Department of Public Health said it "believes there is no continuing risk to the public."  Read More

•  According to the Congressional Budget Office (CBO), the American Health Care Act, which is the repeal and replacement to the Affordable Care Act, would reduce the federal deficit by $119 billion by 2026 but would also leave 23 million people uninsured. The CBO also projects that premiums would rise in the coming years.  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 think there is going to be another shake up across cardiology practices around the country.  I’ll tell you why, but first, please indulge me with a metaphor.

Volcanoes.  I recently saw one at the big island in Hawai’i, where you can see it doing its work in relieving the pressure, the urgent need of Magma (Magma is such a great word!  I’m going to see how many times I can work it in.  Try not to pronounce it in your head right now - Magma…) in that particular place in the world to come forth and create land, changing everything around it.  What’s driving it?  Pressure.

The pressure that comes to mind in our case is the differential in earnings and in RVU (relative value units) output between cardiologist practices employed by hospitals and those in private practices.  RVUs are the building blocks of how Current Procedural Terminology, or CPT,  codes are valued.  In 2015, according to Medaxiom, hospital-employed cardiologists were paid, on average, $120,000 a year or approximately 20 percent more than their private practice peers and produced 12 to 15 percent fewer RVUs.  This gap appears to be declining somewhat but in a market as large as cardiology, you can bet the pressure is building as hospitals consider how to get as much from their cardiologists per RVU as private practice doctors produce and the private doctors forever consider the greater economics and better quality of life of hospital employment.

There are other pressures as well and one need look no further than the common cardiology ultrasound study called echocardiography (echo).  In 2008, a private practice cardiologist was paid about $356 for an echo by Medicare.  In 2017, the rate has fallen to $166.52.  Since 2010, again according to Medaxiom, cardiologists have ordered an echo on 24 to 25 percent of their patient visits, so it’s quite common and an important source of practice revenue.  Since the cost of the technology has changed little over that time period, private practice profitability has declined.  At the same time, the reimbursement for hospitals for the same outpatient service held steady and in 2017, the cost comes out to $449.68 per echo.  So a hospital can get paid almost $300 more for the exact same service.  Do you see what I see?  I see the ability to exploit price differences, or, what we like to call, arbitrage!

This same circumstance existed with nuclear studies and, together with echos, it meant hospitals could buy up community cardiologists, pay them a portion of the reimbursement increases as salary, and pocket the difference.  This has been a prime driver of the pay and productivity gap.  Free money from cardiac imaging pumped up salaries and lowered the imperative to see more patients to justify those salaries.  The market responded with cardiologists continuing to migrate from private practice employment to health system employment.  Currently, about 52% of cardiologists are employed by hospitals.

All good right?  Free money, new models with higher pay and lower work: no problem!  Well, the government began to take notice and eventually, the Bipartisan Budget Act of 2015 was created. This act stated that these hospital rates, called HOPPS (Hospital Outpatient Prospective Payment System), would be cut by 50% for anything not existing as of the date the law was signed on November 2, 2015, which effectively ended the ability of hospitals to grow this arbitrage (no more Magma for you!).  One can imagine that lobbying prevented the 50% cut to everything, though this would seem ripe for future cost savings.

Where does this leave us today?  I would be very uneasy if I were dependent on higher than justifiable reimbursement. The underpinnings, like the cone of a dormant volcano, are being animated by the gases of fading arbitrage.   

The solution?  Think about smarter ways in which work is turned into revenue. Build tighter clinical, financial, and operational links. Build muscle in how to collaborate across settings to do well in bundled payments.  Pick a wise, motivated, creative technology partner with the skills to get you there and with a shared dream of efficiency, simplicity and interoperability.


Image: Mark Fiore for KQED

Here's The Latest in Health Care:

•  Officials warned Wednesday that some blood tests used to check for lead poisoning in women and children since 2014 may have inaccurately reflected safe results from lead exposure, providing false assurance to parents. It is recommended that children under the age of 6 and pregnant and nursing women be re-tested.  Read More

•  The Centers for Medicare & Medicaid Services announced Wednesday that four additional regions will have the opportunity to participate in the Comprehensive Primary Care Plus (CPC+) model from 2018 to 2022. The CPC+ program rewards primary care providers on value and quality of care. The first round began this year and included 2,800+ practices across 14 regions.  Read More

•  Veterans are being left in the dark about their tax credit fate under the revised American Health Care Act (AHCA), the newest effort to replace the Affordable Care Act (ACA). Under ACA, veterans could take advantage of tax credits to help offset the cost of purchasing insurance coverage, regardless of whether or not they were enrolled in care through the VA. Under the revised AHCA, there are concerns on whether or not those veterans are eligible to get the tax credit.  Read More

•  While digital addictions are not official mental disorders listed in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), there's debate among psychologists as to whether that should change. Addictions begin with intermittent or recreational use and progress into daily and sometimes life-threatening use. Psychologists are now seeing a classic addictive pattern of behavior among many internet users.  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.

Image: The New York Times

Here's The Latest in Health Care:

•  The Centers for Disease Control and Prevention released a report Thursday which found that the number of new Hepatitis C cases skyrocketed to nearly 300 percent from 2010 to 2015. The likely culprit: the use of heroin and other injection drugs. Researchers are urging lawmakers to create public health laws to fight the disease.  Read More

•  Providers and payers have began to make investments in IoT (Internet of Things) technologies and programs, anticipating the potential to receive significant financial benefits over the next three years. The Internet of Health Things, or IoHT, is already delivering cost savings but continued investment is essential for long-term success.  Read More

•  Hospital mergers were off to a strong start in the first quarter of 2017 and there are no signs of slowing down. Not all hospitals, however, are choosing this route to offset costs. Being consolidated into another health system is only one strategy hospitals are turning to in order to lower costs and improve the quality of care and patient experience.  Read More

•  A recent analysis found that pain relievers known as nonsteroidal anti-inflammatory drugs can carry cardiovascular risks that may arise within a week of starting the drugs, with the potential to increase with higher doses and duration of treatment.  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.

There have been a lot of changes in health care over the past few years. With so much changing in the health care profession, are providers overwhelmed or happy with these changes? How will the changes that are being asked of providers today affect how patients are cared for tomorrow? The 2016 Survey of America’s Physicians highlights some very interesting findings about physicians’ morale and ability to adapt.


When providers were asked, “Which best describes your professional morale and your feelings about the current state of the medical profession?”, 53.9% said somewhat or very negative while the remaining 46.1% said somewhat or very positive. How does this affect patients? Providers who are unhappy could retire, switch to concierge medicine or switch to a non-clinical position, all of which can limit patient access to the best care possible.

What Makes Them Happy? PATIENTS!

71% of physicians describe “patient relationships” as the most satisfying aspect of medical practice. While providers may go through some industry changes over the next few years and beyond, they will continue to value their relationship with their patients the most. The survey also found that after patient relationships, physicians value the intellectual stimulation of practicing medicine.

Ability to Adapt

Health care is an ever-changing landscape that keeps providers guessing at what might be coming next. Only 56.3% of physicians that took the survey indicated that they are very or somewhat unfamiliar with MACRA, or Medicare Access and CHIP Reauthorization Act. MACRA made several changes to existing health care laws, including restructuring Medicare payments. It is the newest solution to the ongoing challenge of shifting Medicare payments from fee-for-service to value-based care. How will this type of quality-based incentive program affect providers who submit to Medicare? For most, these type of programs add a slight change in workflow, causing providers to focus more on documentation and billing, and less on actual face-to-face time with patients. A small number of providers (27%) have even started to limit the number of Medicare patients they see.


Advances in technology, particularly mobile technology, are able to offset the administrative burden so that doctors can get back the time for their patients. We need great mobile technology that can go where the doctor goes and allows them to spend more time being a doctor and less time acting like an accountant with an expensive medical degree. This extra time with patients can see downstream effects of improved provider productivity, overall better care and happier, healthier patients!

Image: FierceHealthcare

Here's The Latest in Health Care:

•  After weeks of political tug-of-war, the House managed to pass the Republicans' replacement to the Affordable Care Act. House members voted on Thursday, resulting in a narrow margin in favor of the GOP. Democrats have made clear that they will unanimously oppose the bill.  Read More

•  With summer just around the corner, experts warn of increases in a tick-borne virus called Powassan. Over the past 10 years, 75 cases have been reported in the northeastern states and the Great Lakes region of the U.S. The virus is found to be potentially life-threatening. The most common symptoms are fever and headache, although most infected people will never show symptoms.  Read More

•  Days after Republican Rep. Will Hurd introduced a new IT modernization bill dubbed the Modernizing Government Technology Act, President Trump signed an executive order creating the American Technology Council. This organization will be aimed at modernizing the federal government's IT systems.  Read More

•  The Centers for Disease Control and Prevention recently released new guidelines in an effort to prevent surgical site infections (SSIs), updated from the last released guidelines in 1999. Some of the updated recommendations include using an alcohol-based product to cleanse skin in the operating room, not using topical antimicrobial substances in an incision, maintaining the patient's normal body temperature and more.  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.

As our customers grow and evolve their medical practices, they need to be able to do sophisticated analysis of their patient data. This is essential to ensuring that they’re able to run their businesses efficiently, and provide the best possible outcomes for their patient population. pMD has always had a set of reports that are available for our customers to run on demand, but, as our users have begun to utilize pMD to capture and track quality (MIPS, OPPE, etc), transition of care, and post-acute follow-up data, the breadth and depth of their datasets has grown significantly.

To support these growing reporting needs, we’re building a dynamic Online Analytical Processing (OLAP) reporting tool. The idea is to give our customers a mechanism to define the kinds of questions they want to ask of their data, then build a multidimensional data “cube” capable of providing realtime answers to those queries. Users will be able to export the raw data into a spreadsheet, and will also have the option of doing an analysis in our new visualization tool.

What types of questions are pMD customers asking? There is a large variety, but take for example a line of questioning a practice manager might have about his/her group’s readmission rate: “How many of the patients whom we discharged from the hospital in the last month had a readmission within one week?”; “What was the most common diagnosis”; “How many of those readmissions occurred on a weekend?”; “How many were attributed to each of my providers?”; etc. Or, consider a nephrology practice that might want to analyze their Monthly Capitation Payment (MCP) data: “Show me a breakdown of comprehensive vs. limited visits for each of my dialysis units for the last quarter”; “Of those, which provider had the most comprehensive visits?”; “What’s our most popular day of the week for dialysis, per unit?”.

This is just a small subset of the types of questions groups have told us they want to be able to ask. And the really interesting, and challenging aspect about supporting this type of reporting is that folks don’t always know in advance exactly what they might want to ask of the data. Finding the answer to one question often leads to several more questions. The ideal reporting tool tries to accommodate this by allowing the user to “drill-in” to their data, down to a very granular level, in order to understand their patient population. Armed with this business intelligence, we think the feature set we’re building will give our users a powerful new tool for running their businesses.


Image: Dan Herrick/Lonely Planet Images/Getty Images

Here's The Latest in Health Care:

•  A study based in Germany found that binge drinking is associated with an increased heart rate known as sinus tachycardia. The study was conducted over the course of the iconic 16-day beer festival, Oktoberfest. Scientists of this study were particularly interested in what's known as "holiday heart syndrome", in which binge drinkers suffer potentially dangerous atrial fibrillation.  Read More

•  With all the new government requirements imposed on physicians, more specifically the Meaningful Use program, the Centers for Medicare and Medicaid Services has created a centralized and more accessible repository as a source of health information for eligible professions. The information within the repository was collected in September and October of 2016.  Read More

•  A drug-resistant fungus called Candida Auris is circulating in the U.S. and is severely affecting the New York and New Jersey areas. The Centers for Disease Control and Prevention has found that the fungus can persist on surfaces and is easily spread between patients.  Read More

•  On Thursday, House Republican leaders failed to round up votes for their bill to repeal the Affordable Care Act, losing the opportunity for a major legislative win in Trump's first 100 days in office. This hot topic continues to pull Democrats and Republicans to opposite sides of the health care spectrum.  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.
In the health care industry, we see advances in technology and science as a way to improve patient care. But what if we look at a more fundamental pillar? Communication, especially expectations, can be generally improved in any scenario. The expectation that a patient’s care team is on the same page is understandable because we now have electronic medical records that are updated in real-time and are accessible 24/7. However, that does not necessarily mean that each provider is up to speed and it does not replace the need for improved communication.  By managing these expectations through better communication, can we increase positive health care outcomes?

Challenges in Communication

We’ve all heard the phrase, ‘the left-hand doesn’t know what the right-hand is doing’ and unfortunately, this happens within the health care system far more than anyone would care to admit. Patients no longer go to see just one doctor but are now fitted with a whole team of physicians who are responsible for their care. In fact, according to research conducted by the Columbia Medical Review, the following statistics highlight the number of physicians on a patient’s case:

On average, a typical surgery patient can have 27 providers on their case and elderly patients an average of 11 providers in a single year.

The average Medicare provider will be coordinating care with 229 other individual physicians across 117 different companies. With such an arsenal of individuals all expected to be on the same page surrounding a singular patient’s care, it is little wonder why we have the spotlight on improving communication in health care through the use of technology.

Communication and Patient Safety

It is not feasible to expect physicians to attend every meeting or conversation regarding each individual patient’s care while also maintaining a full-time schedule. In addition, operating independently can not only be cumbersome, but also dangerous.  This is where we begin to see communication fall through the cracks and open the door to a larger problem: patient safety.

In a study conducted by the Institute of Medicine, 67% of medical errors were due to a gap in communication. This fundamental pillar, which one would consider a no-brainer, represents two-thirds of all medical errors!

When looking at another study on patient safety, poor collaboration and communication have been found to increase the risk for ICU patients by 180%. This data reflects the importance of communication and that bad communication is impacting patient care in negative ways.

Advances in Communication

The good news is that changes in technology and government initiatives are helping drive the industry to take up the communication challenge by improving organizational processes and internal systems.

You may have heard of the new quality program, Medicare Access and CHIP Reauthorization Act (MACRA), that begins the reporting period in 2017. But how much of this is communication driven? Actually, quite a bit! Each section of the program has specified items that directly influence the use of technology or processes to improve communication. Some examples include: Communication with the Physician or Other Clinician Managing On-going Care Post-Fracture for Men and Women Aged 50 Years and Older (Quality Measure), Secure Messaging (ACI Measure), and Implementation of Improvements that Contribute to More Timely Communication of Results (Improvement Activity).

At pMD, we’re building a platform to bridge such communication gaps within medical communities. With secure and HIPAA-compliant messaging, automated notifications, and intuitive software, we’re providing a platform for organizations to stay connected and keep everyone up-to-date, allowing for the best possible care.


Image: Mike Kemp/Rubberball/Getty Images

Here's The Latest in Health Care:

•  Researchers have turned their attention to the skin of certain frogs, whose mucus can be used to fight flu viruses. This mucus contains antimicrobial peptides, which can neutralize bacteria, fungi and viruses in our immune system. Recently published findings have found that these peptides were just as effective as some antibiotics in fighting bacteria.  Read More

•  Virtual reality is being used as a method to identify fall risks in the elderly population. By disrupting a person's sense of balance, researchers are able to disorient study participants as they walked on a treadmill and recorded their movements. Researchers are interested in learning more about the specific muscle responses that contribute to loss of balance.  Read More

•  The Food and Drug Administration (FDA) announced on Thursday that drug manufacturers will be required to update their package inserts to reflect the strongest warning type, alerting doctors and parents to the sometimes fatal consequences of certain painkillers used in children. Harsher restrictions have been imposed by the FDA regarding the use of opioid codeine and tramadol in young children and nursing mothers.  Read More

•  In a recent study, researchers have found a protein in human umbilical cord blood that, in aging mice, improved memory and learning. While there is no indication that it would work in humans at the moment, it's an intriguing glimpse into the potential therapies that might someday work to prevent illnesses that are age-related.  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.