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.



Here's The Latest in Health Care:


•  Past studies have struggled to determine whether workplace wellness programs actually improve the health of employees and if it’s worth the $8 billion industry that it’s become. A large-scale study, recently published by the University of Chicago and Harvard, has discovered that incentives and a more targeted approach to these programs may be the key to positive health outcomes.  Read More

•  Telehealth is currently being utilized by 1 in 5 physicians, a 5% increase since 2015, and is expected to skyrocket in the next few years. A new survey from American Well, found a correlation between physicians’ likelihood to use Telehealth and physician burnout.  Read More

•  OrthoAtlanta, one of the largest physician-owned orthopedic and sports medicine practices in the greater Atlanta area, has started using an AI-powered, voice-enabled digital assistant, named Suki. The technology leverages artificial intelligence to become a digital scribe, capable of completing notes to ease the burden of documentation by clinicians. The practice saw their average note completion time decrease significantly and, overall, resulted in many other advantages.  Read More

•  A hand-held ultrasound scanner, called the Butterfly iQ, is being utilized in rural countries that have limited access to X-ray machines, CT and MRI scanners. In some African villages, the scanner is being used to check for pneumonia and other potentially fatal conditions. The battery powered device, which can connect to a mobile phone, is expected to have huge diagnostic potential.  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, secure messaging, clinical communication, MIPS registry, and care navigation software.


Here's The Latest in Health Care:


•  In a new study, research suggests that sitting for more than 13 hours a day can cause metabolic problems, even with exercise. Exercising can improve our metabolisms and keep our blood sugar and insulin levels steady. Being inactive, however, has the opposite effects, raising the risk of diabetes and heart disease.  Read More

•  Interoperability in health care should not only be thought of as a goal but also as an ongoing process that continues to evolve and be redefined with emerging technologies. One health care expert says health care should simplify its approach to data exchange by focusing on worthwhile use cases, sharing first, and then standardizing later. A more unified infrastructure should be in place in order for patients to access their entire medical record.  Read More

•  New York City is now declaring a state of emergency and calling for mandatory vaccinations after over 285 cases of measles have been reported since October. Brooklyn neighborhoods, Williamsburg and Borough Park, have been hit the hardest. All unimmunized children and adults in this area are mandated to receive vaccinations and those who do not comply could incur fines and violations.  Read More

•  Walgreens is opening a series of primary care clinics in Houston as part of its new health care delivery models and in partnership with VillageMD. The first locations are scheduled to open by the end of the year, with plans to possibly expand in Texas and other markets.  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, secure messaging, clinical communication, MIPS registry, and care navigation software.





For over 10 years, I worked in the finance industry. There were many things I liked about it and I learned so much, but last year I made a drastic switch to the health care technology industry. You may ask why the big change? Why walk away from an industry that has so many financial benefits? The answer for me was family.

Recently, my family had to deal with some pretty serious health situations that made me reflect on how and where I was spending my time. Making the transition into the health care industry and to a company that is truly doing something meaningful, like improving patient care, was important to me.

For the last 3 years my dad has been on dialysis. Before he started, aside from knowing that he had to undergo a procedure that had to do with cleaning his blood, I had no idea what the world of dialysis entailed and the toll it takes on a person and their family. My dad’s situation led me to want to learn more about dialysis, the benefits of home dialysis, the latest technology, and how it can improve the lives of patients like my dad.

Through my dad’s experience, I got to see first-hand the toll it takes on a person and how it affects a family. The dialysis process is a huge time commitment. He was hooked up to a machine for 5 hours a day, at least 3 days a week. The wear on his body was pretty intense - he was wiped out after dialysis, so much so that it was hard for him to drive himself home afterward. Our biggest concern was that he could potentially fall asleep at the wheel.

All this made me wonder what, if anything, he could be doing to improve his quality of life? My research led me to home dialysis.

Before we talk about dialysis, let's talk about your kidneys and what they do

Your kidneys filter extra water and waste out of your blood to make urine, they help control chemicals and fluid in your body, help control your blood pressure, help keep your bones healthy, and help make your red blood cells.

When your kidneys don’t work the way they should, they allow waste and water to flow back into your bloodstream. Poor kidney function makes it harder for the rest of your body to work the way it should. Chronic Kidney Disease (CKD) occurs when kidneys are no longer able to clean toxins and waste from the blood and perform their functions to full capacity. This can happen over time or all of a sudden! Kidney failure, or end-stage renal disease (ESRD) is when your kidneys fail. It means they have stopped working well enough for you to survive without dialysis or a kidney transplant.

Out of the approximately 100,000 people on the transplant waiting list, there are only enough kidneys for 20% of patients. That leaves 80% or 80,000 patients with kidney failure whose only hope for survival is dialysis.

Let’s look at some interesting and scary statistics

1) 1 in 3 American adults is at risk for kidney disease.

2) 30 million people or 15% of U.S. adults are estimated to have CKD (that’s 1 in 7 people). Most aren't even aware of it!

3) Kidney disease often has no symptoms in its early stages and can go undetected until it is very advanced.

4) According to the U.S. Renal Data System, in 2013, among fee-for-service Medicare patients, total medical costs were $50.4 billion for CKD (excluding ESRD), and another $30.9 billion for the ESRD patient population.

In my research, I learned that recently a couple of celebrities have spoken very openly about their struggles with kidney disease:

* Actor, Sarah Hyland (Haley of Modern Family), discussed in the December 2018 Issue of Self magazine both her physical and mental struggles with CKD.

* In October 2017, in an interview with Today, Selena Gomez opened up about the kidney transplant from her best friend that saved her life.

So what is dialysis?

Dialysis is a way to artificially clean the blood if your kidneys can't. It rids your body of unwanted toxins, waste products, and excess fluids by filtering.

There are two types of dialysis:

1) Hemodialysis is the most common - during hemodialysis, your blood travels through tubes from your body, through the dialysis machine, and back to your body.

2) Peritoneal Dialysis is done inside your body. The inside lining of your own belly (peritoneum) acts as a natural filter. Wastes are taken out by means of a cleansing fluid, which is washed in and out of the belly in cycles.

Where is dialysis done?

Dialysis can be done in two locations, either at a dialysis center, which is the most common, or in a home setting.

Compelling benefits to home dialysis:
- Better clinical outcomes and can be gentler on the body
- Quality of life benefits - less travel time and expenses, improved understanding, lower rates of depression, unemployment, and more overall flexibility.

There have also been some industry changes that are making it easier to do home dialysis:
- Medicare is now taking steps to make it easier. 
- New machines are now more patient friendly and smaller.
- New technology is improving communication with the machines and the doctors.
- Telehealth - Congress is allowing for remote telehealth visits with a nephrologist under Medicare, providing even more flexibility.

How does pMD fit in?

pMD not only cares deeply about doctors, but also about patients. The care of a dialysis patient takes a team and pMD’s Care Coordination tools give care coordinators, nurse navigators, social workers, and specialists a way to share information. With the release of pMD’s video chat capability, providers are now able to connect with a patient from their home.

I’m happy to say that my dad is part of the lucky 20% that has received a kidney transplant and I’m lucky to work at a place like pMD that cares so much about patients.

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.



Here's The Latest in Health Care:


•  How well do you know this week's latest news in health care? Take the quiz to find out!  Read More

•  Experts in health IT consulting offer advice on software implementation best practices. Where best to start? To ensure success, they recommend beginning relationships with consultants as early as possible. By engaging consultants early in the process, health care organizations can discuss alternatives before predetermining which technologies to use and implement.  Read More

•  Poor diets are responsible for about 11 million deaths a year around the globe. As a planet, many diets lack whole grains, nuts, seeds, fruits, and vegetables and are supplemented with too many sugary drinks, salt, and processed meats. When it comes to ending hunger and improving health globally, we don't just need food, we need nourishment.  Read More

•  As care begins to shift away from physician offices to outpatient settings, we see the cost go up for those services. This comes at a time when more and more medical practices are being absorbed by hospitals and large health systems. Services in the outpatient setting tend to be more expensive and also tend to increase at a faster rate.  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, secure messaging, clinical communication, MIPS registry, and care navigation software.


Here's The Latest in Health Care:


•  In a recent study, researchers point out how quickly the adverse effects of chronic sleep deprivation, which includes weight gain and increased risk of Type 2 diabetes, can kick in. However, by making up for loss of sleep in the short term, like long weekend sleep to compensate for short weekday sleep or by taking naps, you're less likely to have an increased risk of premature death.  Read More

•  Proper communication amongst care team members is critical and can directly impact patient care. When implementing clinical communication technology, it's important to have the buy-in of the entire organization. Why? While organizations are provided with the software tools, it's the responsibility of everyone in the organization to ensure internal optimization and collective use of those communication tools. It takes a large amount of time, commitment, and resources to do it right.  Read More

•  Experts in nutritional psychiatry argue that fresh and nutritious food can be a potent addition to more traditional therapies such as prescribed medications and therapy. A recent study has shown that there are higher levels of mental health and well-being among those who ate more fresh fruits and vegetables.  Read More

•  The Centers for Medicare and Medicaid Services (CMS) updated Medicaid regulations for community and home-based health facilities for certain beneficiaries. The aim of this new guidance is to remove bias against certain types of health care settings and allow providers the ability to meet the rule's criteria while serving individuals in integrated community settings.  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, secure messaging, clinical communication, MIPS registry, and care navigation software.





Coordinating a patient’s care is complex. Professionals from a variety of disciplines deliver care to a single patient at various times throughout the day. Specialists may be traveling from several different locations from across a city to where this one patient is receiving care. And all of this complexity limits the chance for care teams to reliably connect with each other regarding the current plan for a patient’s care.  This is when inefficiencies and medical errors arise.

The growing body of research on medical error prevention reveals that ineffective or insufficient communication among care team members is a significant contributing factor to adverse events. Ineffective communication is at the root of nearly three of every four medical errors. Industry studies have classified communication errors that led to inefficiencies and medical error into a few buckets:

1) Communication that was simply too late to be helpful for the patient.
2) Failure to include the whole care team in communication about a patient.
3) Communications that proposed an action where that action was not completed.

Thus, access to a common communication platform that can link up multiple providers and support clarity in communication during the critical seconds of need must be implemented to help stop avoidable medical errors.

At pMD, we’re passionate about reducing those avoidable medical errors and saving lives. pMD’s HIPAA-compliant clinical communication and free secure messaging platforms are one key way we’re doing just that.

1) We know that texting is a quick, easy method to connect a team and convey information that can save lives. So, we’re proud to provide a proven, secure communication platform to support care teams - for free.  

2) Sending images securely, including labs, diagnostic images, skin conditions, or wounds post-surgery, can link internists to specialists, residents to attendings, and patients directly to triage nurses.

3) We know that with text alone, a message can lose the inflection, emotion, or intensity intended by the sender.  So, we’ll be adding the ability to send and receive voice memos, giving messages back the volume, pitch, rhythm, and speed that can help convey a clear message.

4) And we know that verbal and non-verbal aspects of communication can be vital in ensuring clarity. Therefore, we’ll also be adding HIPAA-compliant video communication capabilities, even to our free secure messaging platform, to execute care team huddles from anywhere, to facilitate the integration of specialists, and to even host telemedicine encounters directly with patients or medical decision-makers.

At pMD, we know a text, picture, voice memo, or video encounter can vastly improve the clarity of communication. By utilizing a common secure communication platform which includes the right individuals at the right time, we can reduce medical errors and save thousands of lives.  For more information, or to easily sign up for free pMD® Secure Messaging™, please visit us here!

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.



Here's The Latest in Health Care:


•  The Department of Health and Human Services (HHS) recently proposed a new rule to improve the interoperability of Electronic Health Information between different health systems. In a recent press release, HHS will require the health care industry to adopt standardized application programming interfaces (APIs) to allow seamless movement of health information from one system to another by 2020. This has been a long-awaited victory for patients, now giving them the accessibility they need to view their medical and insurance records from any device.  Read More

•  In a report published Thursday, the Centers for Disease Control and Prevention highlighted the start of the nation's third opioid epidemic wave with fentanyl at the center of it all. Fentanyl is a powerful synthetic opioid that offers a particularly potent high but can also shut down breathing in under a minute. What's fueling the recent spike in fentanyl deaths? The drug is easy to produce due to its synthetic nature, making it easier for drug dealers to traffic and for users to get a hold of it.  Read More

•  As technology begins to drive the health care industry, providers need to be cautious not to lose the element of humanity in how they deliver care. Telehealth can be a powerful tool to gather data and logic but if handled well, it can also be a compelling model for quality patient care. It's important to think of telehealth as a virtual starting point in providing convenient, transparent, and quality care, remembering to incorporate a personal touch and acknowledging the value of both the provider's and the patient's time.  Read More

•  Artificial Intelligence (A.I.) - a concept that's been sensationalized in Hollywood films and a reality that's slowly starting to make its way into health care. A new breed of artificial intelligence technology is rapidly spreading across the medical field in which systems and devices are able to detect signs of illness and disease in a wide variety of images, such as C.A.T. scans and X-rays. However, scientists warn of a dark side of A.I. where small manipulations can change the behavior of A.I. systems. The biggest concern is of these devices or systems getting into the wrong hands of those who would manipulate A.I. to misdiagnose patients for the purpose of maximizing on insurance reimbursements.  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, secure messaging, clinical communication, MIPS registry, and care navigation software.





As we approach the submission deadline for 2018 MIPS reporting and find ourselves in the second quarter of 2019, it’s important to understand the changes that are in store for this upcoming reporting year. As a qualified MIPS registry, pMD gives customers the tools to submit their 2019 MIPS data to CMS and navigate some of these changes using our robust dashboard. As there are a lot of updates to the MIPS reporting requirements each year, I would like to address a few of the many questions that have recently come up.

Changes to Eligibility

In prior years, the list of clinician type has been fairly short to only include physicians, their mid-level providers, and nurses. Starting in reporting year 2019, there are 6 additional clinician types that are now included in MIPS reporting:

Physical therapists
Occupational therapists
Qualified speech-language pathologists
Qualified audiologists
Clinical psychologists
Registered dietitians or nutrition professionals


Find yourself on this list?  There is no need to panic! You can easily check to see if you are required to report based on your Medicare Part B volume by using the Quality Payment Program’s tool: QPP Participation Status

For the first year since the program began, clinicians who were previously ineligible to report can opt-in beginning Year 3. Physicians interested in this must meet at least one of the following criteria and are an eligible clinician type:

1. Have ≤ $90K in Part B allowed charges for covered professional services
2. Provide care to ≤ 200 Part B-enrolled beneficiaries
3. Provide ≤ 200 covered professional services under the Physician Fee Schedule (PFS)

Interested in opting-in to MIPS this year?  Keep in mind that opting-in may be irreversible, but stay tuned for an announcement from CMS QPP on where and how to opt-in later this year!

Changes to Submission

In previous years, claims-based submission was a viable option for many clinicians and organizations to report.  This year, claims submission is only available to small practices who have less than 15 providers. Larger groups may want to look into submitting through a qualified registry, QCDR, or your EHR. Questions about how to submit through a qualified registry? Give us a call at 800-587-4989 x2 to discuss your reporting options!

Individuals, groups, and virtual groups can begin to use multiple submission mechanisms for Year 3 reporting so you are no longer locked in to using just one mechanism or vendor. This change should make it easier for clinicians and health care organizations to leverage the tools they already have to submit different sections of reporting. The QPP has increased their capabilities, allowing the review of multiple submissions, selecting only the highest scores to keep as the final one for determination. In fact, they list out that “if the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring.“

Changes to Scoring

One of the more notable changes to Year 3 is the change to the final score breakdown. The contribution to the final score for the Quality category decreases to 45% and increases to 15% for the Cost category. There are no changes to the contributions of Promoting Interoperability or Improvement Activities categories.





Another change to the Quality category is that the small practice bonus for groups with less than 15 clinicians is awarded to the Quality section so long as there is at least 1 quality measure reported. This differs from Year 2 which awarded the 5 points to the final score total.

Changes to Payment Adjustments

As the QPP rolls out the MIPS program in stages, we will see increased difficulty in obtaining a positive payment adjustment. The first year of MIPS offered a “Test” submission in which by submitting any data, clinicians can easily avoid any penalties.  Last year, clinicians just had to score 15 points to avoid the penalty and be eligible for a positive payment adjustment. Beginning in calendar year 2019 (MIPS Year 3), the performance threshold had been increased to 30 points. Clinicians scoring under 30 points for their MIPS Final Score are subject to a negative payment adjustment. For groups trying to obtain the Exceptional Performance bonus, that threshold was also increased to 75 points.

Speaking of payment adjustments, the maximums have been increased for them as well.  Clinicians who fail to sufficiently report MIPS are subject to a penalty of up to -7% payment adjustment on Medicare Part B FFS payments. On the flip side, the maximum bonus can be up to a positive 7% payment adjustment - however, to keep budget neutrality, it will depend on overall submission performance and will be scaled and distributed appropriately.

A full list of changes to the Year 3 Final Rule and the most up-to-date information can be found on the QPP website.

Questions on your 2019 reporting options?  Feel free to take a look at what we offer for MIPS reporting here, or give us a call at 800-587-4989 x2!

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.



Here's The Latest in Health Care:


•  Hate exercising? Well, new research shows that exercise can lower blood pressure and reduce body fat as effectively as many common prescription drugs. While there's still a need for long-lasting studies that directly compare different drugs and various workout types, you might want to reconsider skipping out on gym time or that weekend hike!  Read More

•  If a new government-run Medicare public option were to be rolled out, more than 36 million people would likely leave private coverage. What would that mean for U.S. hospitals? It would mean a nearly 10% cut in the cost of providing care, threatening the ability of providers and clinicians to meet the needs of their patients.  Read More

•  As data analytics become increasingly important to the success of health care organizations, proper implementation of analytics technology is critical in maintaining that success. Some implementation best practices include defining outcomes that will be key to the success of the organization, starting with applications that can show an immediate impact by freeing up time and cost, and making sure technology vendors and CIOs work closely with clinical sponsors and management on all new initiatives.  Read More

•  Controlling anger as a parent can often times prove challenging. And teaching your little ones to control their own anger is a lesson in itself. One anthropologist spent more than 30 years studying Inuit adults' extraordinary ability to control their anger and instill this in their children.  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, secure messaging, clinical communication, MIPS registry, and care navigation software.





Last year we were excited to announce the launch of our free Secure Messaging product, which is now enabling thousands of health care providers across the United States to communicate in a way that’s convenient and secure. As that offering has gained adoption, we’ve been actively soliciting feedback from our user base in order to understand how we can continue to make the product better for them. One of our biggest takeaways has been that, while secure text messaging has indeed addressed a major pain point, there are additional scenarios where a richer form of communication would be helpful.

That’s why we’re excited to announce the upcoming release of secure video calling capability.  This new feature will enable providers to utilize pMD to quickly get a second opinion from another clinician, connect with a nurse at a remote clinic, or even chat directly with a patient who may not be able to leave his or her home. Best of all, video calling will be built in to our free Secure Messaging product.

We know that often, vendors dangle new features behind a paywall, or an upgrade requirement, rather than shipping them directly to their customers. However, our philosophy at pMD has always been, first and foremost, to help clinicians provide better patient care.  The cutting edge design agency, Chagency, sums up this approach well in a recent blog post, suggesting, “Help [your users] grow so you can grow together.” To accomplish this, we push down as much value into our free offering as we possibly can, knowing that the more people who benefit from pMD, the bigger the impact we’re able to have on health care in this country.

We’re extremely excited about this upcoming enhancement to pMD’s product suite. We look forward to continuing to gather feedback from our customers as they leverage this new tool to improve their care delivery. Most importantly, we’re not done innovating. In fact, we’re just at the beginning of a compelling roadmap of new features to empower richer communications in health care.

 

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.