The pMD Blog

Image: New York Times/Craig Frazier

Here's The Latest in Health Care:


•  Vitamin D deficiency is likely being over tested and over treated, according to a recent study in Maine. Vitamin D popularity began back in 2000 when medical journals began publishing studies of illnesses believed to be linked to vitamin D deficiency. As a consequence, healthy people who believe they have a deficiency are taking dangerous levels of supplemental doses.  Read More

•  A study published in JAMA this week found that value-based programs yield lower hospital readmission rates and significant cost savings. Researchers examined 2,837 U.S. hospitals between 2008 and 2015 and found that participation in 1 or more of Medicare’s value-based programs, including Meaningful Use, Accountable Care Organization, and the Bundled Payment for Care Initiative, was associated with greater reductions in 30-day readmission rates.  Read More

•  It’s now easier for physicians to get licensed in multiple states thanks to the new Interstate Medical Licensure compact, which launched last week. Qualified physicians can apply for licensing in 18 participating states. This agreement will ease the administrative burden for physicians who practice medicine in multiple states, including locum tenens doctors, doctors in metropolitan areas that include more than one state, and doctors who provide telemedicine services.  Read More

•  New analysis by the Pennsylvania Patient Safety Authority shows a rising number of medication errors that were attributed in some part to electronic health records and other technologies used to monitor and record patients’ treatment. Researches attributed the errors to system problems and/or user mistakes.  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: Luciano Lozano/Ikon Images/Getty Images

Here's The Latest in Health Care:


•  Doctors are reimbursed for everything ranging from office visits to lab work to medical procedures. But what about the tasks that pull allocated time away from actual face-to-face visits? Data suggests that doctors are spending a significant amount of time on desktop medicine tasks. The data also highlights a reduction in time spent with patients and yet, physicians are not reimbursed for their EHR time.  Read More

•  Do you find yourself zoning out in the middle of one-on-one conversations? Do you procrastinate more often than not? There are, according to the World Health Organization, six simple questions that can reliably identify whether you have adult attention-deficit/hyperactivity disorder (ADHD). It's important to note that the questions should be looked at in their totality, not individually. No single question stands out as an indicator of ADHD.  Read More

•  The federal government settled on an average rate increase of 0.45% for its finalized 2018 payment rates for Medicare Advantage (MA) plans. The rate announcement gives MA organizations the incentive to develop innovative provider network arrangements, encouraging enrollees to access high-quality healthcare services.  Read More

•  A report published Tuesday by the Centers for Disease Control and Prevention found that 1 in 10 pregnant women in the continental U.S. with a confirmed Zika infection had a baby with serious birth defects or brain damage. There is also more evidence that birth defects were a bigger risk in women who were infected in the first trimester of pregnancy.  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.
It’s no secret that we strive to provide unparalleled customer service at pMD; this is evident in the 650+ testimonials we've received from our customers. This year, we’re taking it an extra step further by not only continuing to provide the same customer service we’ve provided for nearly 20 years but also going out and shaking every customer’s hand in-person!

I recently had the opportunity to hop on a plane and reach nearly a dozen existing customers as well as provide some in-person demonstrations for potential new customers. While check-ins via email, phone, or messaging have strong benefits, there is nothing that can beat meeting a customer or potential customer face-to-face.

24/7 customer support is always a great way to address customers' questions or needs, but the ability to show up in-person at a meeting allows customers to not only get their questions answered but also gives them the chance to hear about any new features that might have gotten overlooked or buried in their inbox.

We always try to maximize our time on customer trips and schedule as many quality meetings with existing customers and potential customers as possible. Ahead of any meetings we study how the customer currently uses our charge capture and/or secure messaging products so we can present them with any new features that could help with their workflow. During this particular trip, we were able to get in front of two potential customers and learn more about their current workflow and needs as well as connect with them on a personal level. Relationship building simply can’t be matched with conversations over the phone.

The overall theme for our account management initiative is to not only build our existing customer base but also to ensure that any potential customers know that we offer a product that is second to none, and that our customer service matches the products we offer. Each and every customer we meet is not only amazed that we travel “just to meet them” but that we also take the initiative to check in without any motive other than to ensure their satisfaction with pMD… and that’s how we define unparalleled customer service.

Image: Mike Albans for Kaiser Health News

Here's The Latest in Health Care:


•  For many home health aides, health insurance coverage was hard to come by, mainly due to employers not offering such coverage or the inability to clock enough hours to be eligible. Cue the Affordable Care Act (ACA), which offered the state-federal low-income health insurance program. With the Trump administration's attempt at repealing the ACA and proposal for budget cuts, this lack of clarity is concerning to home-based care-givers whose paychecks rely heavily on Medicaid and Medicare and whose future health care coverage remains unclear.  Read More

•  The Food and Drug Administration (FDA) is investigating an increased rate of adverse cardiac events in patients with the dissolvable heart stent. The stent, called Absorb, is manufactured by Chicago-based Abbott Laboratories. The FDA and Abbott are working together to understand the cause of the adverse events and encourage physicians to follow the device's label instructions when selecting a target heart vessel.  Read More

•  Under President Trump's proposed budget cuts, funding for the Agency for Healthcare Research and Quality (AHRQ) may be eliminated. AHRQ is the lead federal agency involved with the improvement of safety and quality of the U.S. health care system. It also develops the resources and data for providers and consumers to help them make informed health decisions. Supporters of AHRQ believe the agency's role is misunderstood and that merging it with the National Institute of Health, as proposed by Trump's administration, would threaten its future.  Read More

•  On Tuesday, the Food and Drug Administration approved the first drug to treat a severe form of multiple sclerosis. This disease leads to paralysis and cognitive decline. The drug will be sold under the brand name Ocrevus by Genentech.  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.

From a financial perspective, one of the benefits of mobile charge capture software is a tremendous reduction in charge entry lag. This is the length of the time between when the patient is seen and when the charge is captured electronically - not on a piece of paper where it could be misplaced or accidentally used as a napkin.

Providers who see patients in an office or clinic setting typically have low charge entry lag. Patients come to them and the provider is always in front of a computer, so they can capture billing information at the same time as they're doing other documentation.

Everything changes the moment the provider heads over to see patients at an outside facility such as a hospital or nursing home. Suddenly they are walking from room to room, and they need to improvise a system (typically a paper system) to track what happens as they go along - or they have to reconstruct it from memory later, when they're in front of a computer. Then they have to figure out how get the paper or spreadsheet back to their billing office. This administrative burden can create a cycle of procrastination that leads to weeks of charge entry lag as busy providers struggle to stay on top of their paperwork.

The statistics tell the story. If you're looking for a mobile charge capture solution, you should ask each vendor what their median charge lag is across their entire customer base for these places of service: Hospital Inpatient, Hospital Outpatient / Surgical Center, and Skilled Nursing Facility. If a vendor tracks these statistics, the answers may reveal whether their charge capture solution is usable in real time. If they don't track these statistics, why not? Charge entry lag is one of the key metrics for charge capture software, and you should choose a vendor that helps its customers measure and improve it.

In February 2017, the median (typical) pMD customer had a charge entry lag of 0.06 days at these remote facilities. In fact, 84.9 percent of pMD’s customers had a charge entry lag of less than one day outside of the clinic setting. Of providers who used pMD to capture charges in February, 90.8 percent used the pMD mobile app to do so, and 91.2 percent of all February charges were created on mobile. These numbers prove that practices are living the dream of real-time mobile charge capture. The fast, intuitive mobile app that works offline is key to achieving this.

What does all this mean for a medical practice? If you start out with a charge entry lag of one week at your remote facilities, and you become a typical pMD customer with a charge entry lag of less than one day, then you immediately recover a full week of revenue that had been floating out there somewhere in paper form. You could bill 372 days worth of revenue in a single calendar year of 365 days.

Image: Scott Eells/Bloomberg/Getty Images

Here's The Latest in Health Care:


•  The Food and Drug Administration's (FDA) initiative to control how farmers can give antibiotics to livestock falls short in many areas.  According to the Government Accountability Office, the FDA initiative has not been collecting usage data that allows the program to know if efforts to curb the use of routine micro-doses of antibiotics, known as growth promoters, in livestock have been successful.  Read More

•  Thursday marked another blow to the GOP's efforts to pass the American Health Care Act. House Speaker Paul Ryan did not hold a floor vote as planned after President Donald Trump held meetings with conservative and moderate Republican caucuses, hoping to come to a deal. The House can lose no more than 21 votes for the bill to pass, however there's a likelihood of more than 25 members of the Freedom Caucus who plan to vote "no."  Read More

•  On Monday, an interim rule was released, delaying the expansion and implementation of major bundled payment initiatives. The Centers for Medicare & Medicaid Services say the additional three-month delay will allow the agency more time to review and modify the policy, if necessary. The delay also calls into question whether the new White House Administration is committed to the programs.  Read More

•  Oral health has never been a priority with the aging population. One reason? Medicare does not provide dental care, except for certain medical conditions, and California's Medicaid only covers some services. However, the effort to bring more dental care to older adults is advancing across the nation. New clinics and technologies are popping up to help improve oral health for the aging, such as an app that tracks dentures, which frequently disappear in nursing homes.  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: Dr. Thomas Albini

Here's The Latest in Health Care:


•  Three women between the ages of 72 and 88 had lost most to all of their eyesight after participating in an unproven treatment where stem cells were injected into their eyes. The women later told doctors they thought they were participating in government-approved research after finding the study listed on a government website provided by the National Institutes of Health. Unfortunately, clinical trials do not need government approval to be listed the site.  Read More

•  In Trump's proposed health care budget, the Department of Health and Human Services should expect to see its budget slashed by more than $15 billion in 2018. The Department of Veterans Affairs, however, would see a $4.4 billion increase. The reduction takes funding away from the nation's foremost medical research agency as well as support programs for low-income individuals.  Read More

•  With the new 2017 Merit-Based Incentive Payment System (MIPS) performance period underway, providers are left in the dark as to whether or not they must comply with program criteria. Providers that bill $30,000 or less in Medicare charges or give care to 100 or fewer beneficiaries are exempt from MIPS. The Medical Group Management Association is calling for immediate release of 2017 MIPS eligibility information to find out if clinicians are part of the nearly one-third that are eligible for exemption.  Read More

•  Researchers say that over-the-counter birth control pills would be safe for teens and that there is no evidence that adolescents are at greater risk from birth control pills than adult women. In fact, some of the potential negative side effects of oral contraception are less likely in younger adults, according to Krishna Upadhya, assistant professor of pediatrics at Johns Hopkins University School of Medicine.  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.

We all know from previous posts here, here, and here that BPCI is alive and thriving in the health care world under CMS’ Episode-based Payment Initiatives. We’ve probably talked your ear off by now about what Bundled Payments are… but what’s being done about it and how can you be successful?

To put the concept of bundles into perspective, let’s imagine Medicare has baked you a scrumptious Georgia peach pie. This one pie must be shared amongst your whole family. For example, in the case of BPCI Model 2, which includes acute and post-acute care, we’ll need to split the pie between providers Acute Stay “Anna”, Physician “Phoebe”, and Post-Acute “Polly.” As the biggest players of the group, Acute Stay Anna will take more than half of the pie. Physician Phoebe will then take most of the remaining slice, leaving Post Acute Polly with just a tiny sliver of crumbly crust. How is Polly going to manage?

This situation is synonymous with the dollars distributed per bundle. After so much is spent during the hospital stay, not much is left over for post-acute care. In order to stay below the target bundled price and maximize the gainsharing bonus from Medicare, health care organizations must determine the most cost-friendly, yet still effective way to allocate these final dollars.

Cue: Home Health Care.

Quoting from the medicare.gov website, “Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility.

More and more evidence is arising to support the benefits of utilizing home health care within a bundled treatment plan. An example of particular importance is the involvement of home health care in major joint replacements of the lower extremity. Hip and knee replacement is the most common inpatient surgery for Medicare beneficiaries and cost Medicare more than $7 billion for hospitalization alone in 2013. In a study commissioned by the Medicare Payment Advisory Commission, it was found that the cost for joint replacement patients treated at home was approximately $3,500 less than for patients discharged to a skilled nursing facility, and $8,000 less than those sent to inpatient rehabilitation facilities. With those numbers, it’s not surprising that BPCI patients are more often skipping over SNF and instead sent on their merry way home.

Health care systems are going to have to keep up as CMS continues to add more episode-based payment models to the list. On December 20, 2016, four new mandatory models were announced:
1. Acute Myocardial Infarction (AMI) Model;
2. Coronary Artery Bypass Graft (CABG) Model;
3. Surgical Hip and Femur Fracture Treatment (SHFFT) Model; and
4. Cardiac Rehabilitation (CR) Incentive Payment Model.

So more players are being added to the roster, and more rules added to the rulebook. What does this mean for health care professionals?

Collaboration across the entire health care continuum is going to be pivotal now more than ever - our outcomes depend on it! This brings up the issue of how providers Acute Stay Anna, Physician Phoebe, and Post Acute Polly are going to communicate with each other about their mutual patients. It’s time for care teams to improve communication with HIPAA compliant text messaging or care coordination software. And maybe grab a slice of the Georgia peach pie too.

Image: Fierce Healthcare

Here's The Latest in Health Care:


•  A new study released this week by HealthlinkNY found that New York hospitals that accessed outside patient records reduced patients' average length of stay by over 7 percent and by 4.5 percent for 30-day admissions. The report clearly shows that the benefits of using HIEs are greater when they contain robust patient data and when physicians have experience using them.  Read More

•  Prestigious hospitals across the U.S. are offering more and more alternative medicine therapies. Despite very little evidence that methods such as Chinese herbal therapies and acupuncture actually work, alternative medicine is on the rise. Opposers to alternative medicine are quick to point out that physicians who promote these therapies forfeit claims they belong to a science-based profession. Advocates say these unconventional treatments offer alternatives that have helped patients who could not be cured by modern medicine.  Read More

•  Hospital and Medical groups are among the opposers to the Republicans' Health Care Plan, citing expected declines in health insurance coverage and causing potential harm to vulnerable patient populations as well as threatening health care affordability, access and delivery.  Read More

•  A newly released study found that there are two effective tests in determining the cause of a stillbirth, a death of a fetus at or after 20 weeks of gestation. Both an examination of the placenta and a fetal autopsy helped in approximately 40 percent of cases, and with genetic testing being the third most useful test.  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.


Here's The Latest in Health Care:


•  Will Accountable Care Organizations (ACOs) survive a repeal and replacement of the current Affordable Care Act? One leading health policy expert seems to think so. Paul Keckley, Ph.D., managing editor of The Keckley Report predicts that ACOs will evolve with the ever-changing health care regulations. Studies have shown evidence that ACOs do lead to quality improvement benefits, which will only continue to grow over time.  Read More

•  A recent study, published by the Centers for Disease Control and Prevention (CDC), compared birth outcomes of several hundred pregnant women entered into the CDC's Zika Pregnancy Registry and who were likely to have the virus. It found that women who were infected with Zika were 20 times as likely to give birth to babies with birth defects as mothers who were not infected with the virus.  Read More

•  Health care sites took a hit this Tuesday when Amazon's S3 cloud-based hosting service experienced outages. AWS partners with many health care technology vendors, such as Synapse, PracticeFusion, Philipps and Cognizant, to name a few.  Read More

•  According to a recent article published in the Journal of the National Cancer Institute, we're seeing an upward trend in colon cancer among younger Americans. While overall cases of colon cancer have been decreasing dramatically since the 1980's, cases in people younger than 50 years of age have slowly been on the rise.  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.