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: Andreas Claesson/Courtesy of FlyPulse

Here's The Latest in Health Care:


•  Indiana University's CEO, Dennis Murphy, is taking a new and more interactive approach to the annual "state of the system" address. He's meeting with IU clinicians and staff members face-to-face at various IU Health facilities, hoping to learn more about staff members' concerns while communicating his vision for the system. This active listening and in-person engagement approach by health care leaders has been proven effective in improving patient and staff satisfaction.  Read More

•  A new study published in Occupational and Environmental Medicine found that noise increases the risk of hypertension. Greek researchers studied 420 people living near an airport and tracked their noise exposure. They found that over the next decade after the study began, there were 71 newly diagnosed cases of high blood pressure. This adds to the nearly half of the study population already diagnosed at the start of the study.  Read More

•  We've heard of drones dropping off packages and food orders directly to customers' doors. But what if drones could do more than simply deliver accoutrements of leisure? Researchers in Sweden have been testing out drone deliveries of automated external defibrillators to cardiac arrest patients. While there is still more research to be done, so far the drones have beat the median response time of ambulances to reach patients in out-of-hospital cardiac arrest situations.  Read More

•  Some health care organizations are still running on outdated systems or browsers, remaining vulnerable to malware attacks, such as that of WannaCry on May 12.  Many of these organizations simply can not update due to lack of funding. In an unprecedented move by Microsoft, security patches were released to these out-of-date systems, recognizing the elevated risk of such cyberattacks, where normally such patches would not be released for technology the company no longer supports.  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.

To an industry notoriously slow in its embrace of new technology, the WannaCry ransomware attack should serve as a wake-up call. While it paralyzed computers the world over, WannaCry seemed to have had an outsized effect on the healthcare industry; it hijacked the systems of dozens of National Health Service (NHS) facilities in the UK as well as computers in medical practices all over the world.

No medical professional wants to turn away patients or shut down operations because malicious actors were able to hold their critical data for ransom, but at least some good news came out of this nightmare scenario. Healthcare practices all over the world are now asking themselves what they can do to prevent hackers and criminals from successfully attacking their systems. By incorporating valuable lessons from WannaCry, hospitals can shore up their IT defenses and help prevent future malware attacks. What follows are some of the most valuable lessons healthcare providers can take away from WannaCry.

Update Your Systems

It may not seem like a major concern for hospitals running their day-to-day operations, but outdated systems - ones that are no longer supported or updated by developers - are much more likely to have vulnerabilities that can be exploited by malicious actors. WannaCry spread across computer networks by exploiting a Windows vulnerability that hackers stole from an NSA leak. While Microsoft released a fix for the vulnerability on March 14, the fix did not cover Windows XP, which Microsoft stopped supporting in 2014, and which many computers in NHS hospitals were still running when WannaCry struck.

Even though Microsoft eventually pushed out a Windows XP update to patch up the vulnerability exploited by WannaCry, it was only after the bug had already infiltrated computers all over the world. For future vulnerabilities, companies may choose not to release fixes for outdated systems - and they will definitely choose not to apply such fixes to unlicensed software. In countries like China and Russia, which have avoided implementing strong intellectual property policies, WannaCry has had an outsized effect, since it was able to spread much more easily across systems that ran unlicensed, and therefore outdated, software.

Choose Subscription Software

Of course, ensuring that every operating system and every application is up-to-date can be a time-consuming process. One way practices can avoid having to manually update some systems is by choosing software services (like pMD!) that work on a subscription service model, which are less likely to provide outdated software. By nature, subscription services are constantly updated by developers and automatically deployed to users. Though Microsoft did release a fix for the WannaCry vulnerability in March, a whole month before the malware started actively exploiting it, millions of Windows machines had evidently failed to update and install that fix at the time it struck.

Train Your Staff

Many cases of malware can be prevented with effective staff training. Though the WannaCry malware spread from computer to computer automatically, worming its way across computer networks, many other malware instances enter computer systems when victims themselves inadvertently expose their systems. Employees across all levels of the practice should:

  • 1.  Never click on suspicious links or open suspicious messages, and should always report suspicious activity to their IT administrator or to another appropriate person in their organization

  • 2.  Pay close attention to their passwords by not using the same password everywhere and by enabling two-factor authentication

  • 3.  Always make sure their systems are up-to-date (see the first section of this blog post!). Practices that put in place long-term security education programs that raise awareness of such risks as phishing attempts can prevent future malware attacks and decrease their risk of infection significantly.

For healthcare practices all over the world, the trade-off between cleaning up the mess after these types of malicious attacks and spending the extra time and energy it takes to maintain a proactive technological defense has always existed. However, the wide-reaching and extremely visible effects of the WannaCry attack may have raised the stakes, and will hopefully convince much of the healthcare industry to choose the latter option. Before the next WannaCry strikes, the industry should make sure to be better safe than sorry.

Image: Fierce Healthcare

Here's The Latest in Health Care:


•  As population health management initiatives become more of a priority for many hospitals, EHR vendors like Epic, Cerner and Allscripts emerge as more appealing due to their integrated platforms. Standalone population health management products must compete with these large vendors as hospitals transition to value-based and patient-centric care.  Read More

•  Telehealth patients at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia were recently interviewed about their experience. The feedback was mostly positive, expressing satisfaction with their telehealth visit and praising the convenience. Surprisingly, according to the study, patients preferred to receive bad news via video while in the privacy of their own home.  Read More

•  The Food and Drug Administration (FDA) made history on Thursday after it asked Endo Pharmaceuticals to remove its opioid painkiller, Opana ER, from the market. This comes in the wake of a rising opioid epidemic in the U.S. The drug company responded to the FDA stating that it will review the request and are “evaluating the full range of potential options as we determine the appropriate path forward.”  Read More

•  The merger of Anthem and Cigna, two major health insurance companies, has been blocked by a federal judge, concluding that a merger of this kind would reduce competition in the health insurance market and raise prices.  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 a traditional fee-for-service payment model, providers are retroactively paid for each service rendered on a patient. The incentive for quality care is shadowed by the pressure to deliver additional services in order to receive higher reimbursements. The new Comprehensive Primary Care Plus (CPC+) value-based model is changing the way primary care practices receive payments and shifts the focus to strategies that promote coordinated, patient-centered care.

What is Comprehensive Primary Care Plus?

As of January 1, 2017, the Centers for Medicare & Medicaid Services, or CMS, has kicked off the CPC+ program. CPC+ is a model that aims to strengthen primary care through regional multi-payer payment reform that ties the provider to specific cost targets.

These 5,000 provider participants across 14 selected regions now have the ability to earn bonus fees in addition to their traditional fee-for-service rates. One of the unique aspects of CPC+ is that it is not limited to just Medicare or Medicaid beneficiaries.

The CPC+ application deadline was September 15th, 2016 and approved participants have already been selected in the following regions:

 

 

Care Delivery Requirements

CPC+’s care delivery requirements are broken out over several functional categories:

1) Access and Continuity - Expanded access to a patient’s primary care team. Expanded hours or alternatives to traditional office visits are a couple of ways that this requirement can be met. The goal is to reduce costly urgent and emergency care.

2) Care Management - The identification of high-risk, high-need patients and the provision of longitudinal care and episodic care management in order to improve outcomes for the identified patients. The use of care plans focused on goals and strategies that are aligned with the patient's values and decisions is a key requirement.

3) Comprehensiveness and Coordination - Comprehensiveness builds on the patient / provider relationship that is the center of primary care. It is the ability of a practice to meet the majority of a patient’s health and social needs in pursuit of each patient’s health goals. Achieving this goal includes the use of analytics to identify and prioritize needs of a patient population, offering services within a practice that may have previously required a referral, and facilitating care through co-management or closed-loop referrals with specialists within the community for services that are best provided outside of the primary care practice. These are key components to delivering on this requirement.

4) Patient and Caregiver Engagement - CPC+ requires patient and caregivers to be engaged in the management of their own care as well as in its design and improvement of delivery. Participating practices are expected to organize a patient and family advisory council (PFAC) to help understand the perspective of patients and caregivers on the practice and its delivery of care. Practices will use the PFAC recommendations to help them improve care delivery and ensure that a patient-centric model is maintained.

5) Planned Care and Population Health - The organization of care to meet the needs of the entire patient population a practice serves. Practices are expected to pro-actively offer timely and appropriate preventative care as well as consistent evidence-based management of chronic conditions. Population health will be improved through the use of evidence-based protocols in team-based care as well as identification of care gaps at the population level. Importantly, practices are required to measure and act on quality of care provided at the practice level.

Strengthening primary care is critical to ensuring an effective health care climate. By providing doctors and clinicians with the right tools, CPC+ participants can more readily meet their care delivery requirements. pMD’s care coordination product enables caregivers to communicate with each other about their shared patients, connects health care teams together onto one patient-centric care management platform and allows providers to send secure, HIPAA-compliant messages in real-time about their patients. By allowing providers to focus on spending more time with patients, we can continue to build a health care system that results in healthier patients and more responsible spending of health care dollars.

Image: Centers for Disease Control and Prevention

Here's The Latest in Health Care:


•  eClinicalWorks, one of the largest Electronic Health Record (EHR) software vendors in the U.S., agreed to pay a $155 million settlement after allegedly falsifying its Meaningful Use certification. It's the first time the government has held an EHR vendor accountable for not meeting federal standards designed to ensure quality patient safety and care.  Read More

•  The World Health Organization recently released a study detailing the environmental costs of tobacco. From sucking up resources to releasing harmful chemicals in soil and waterways to contributing to worldwide litter, tobacco's environmental impact adds to the already well-known costs to global health.  Read More

•  Zika testing spiked in the month of May but the sharp increase does not directly correlate to a rise in Zika infections, at least as of now. The CDC recommended in early May that all pregnant women who were potentially exposed to be administered two different tests.  Read More

•  In a recent study published in the Journal of Applied Physiology, researchers have found that habitual coffee drinkers can still receive an athletic boost from caffeine when needed. This opposes the traditional notion that athletes should abstain from caffeine in the days leading to the big event if they hope to gain any performance boost from it on the big day.  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.

If you were to ask 100 physicians what about their job makes them happy, I guarantee “administrative work” would not be at the top of any lists. The same goes for advanced practice providers, nurses, and other clinical support staff. No one goes through the long and specialized process of becoming a health care practitioner with the goal of completing paperwork all day!

Providing excellent patient care is usually the number one focus of medical practices. While programs such as the Merit-based Incentive Payment System, or MIPS for short (formerly PQRS) are extremely important for assessing themes in the quality and cost of health care, the path to collecting that mandatory data has not always been an easy one.

Because the type of health care data providers are required to report to the Centers for Medicare & Medicaid (CMS) is a combination of clinical and billing information, it can be extremely difficult to capture this data at the point of care in most electronic medical record systems. By the time the information gets to billing and the required quality data has been identified, sometimes days or weeks later, the doctor is usually no longer actively treating the patient, and the biller isn’t sure where to find the clinical information.

The disconnect between clinical and billing causes such an arduous back-and-forth between different employees and software systems in a practice that many doctors choose to wait until the end of the year to even think about reporting quality data to the government. While this is certainly one option, I know from personal experience that this data collection method is not done without significant difficulties.

Reporting quality data at the end of the year through a qualified registry involves obtaining a comprehensive report with detailed information for all of the patient encounters that occurred during the calendar year. I worked with several practices who used pMD’s PQRS registry for the 2016 reporting year. Some of them were able to pull this report after one or two tries, while others had to request multiple iterations (sometimes over 10 versions!) of the data from their billing company.

Once the report is finally complete, some registries such as pMD’s can systematically identify which patients qualify for the practice’s chosen quality metrics. Other registries cannot, and the practice must manually identify these patients. The final, and usually most time-consuming step, is to then find and review each of those qualifying patients’ medical records to actually provide the government-mandated data! I’ve spoken to providers and administrative staff who have dedicated multiple days and even weeks to this chart review process.

Nearly everyone who has worked on chart review laments, “If only we had recorded this information at the time we saw this patient!” Not only would that save many hours of administrative time, it would also ensure the information was recorded at the time the action was being performed, ensuring a high level of accuracy.

pMD has integrated our MIPS registry services with our charge capture product, allowing providers to capture their quality data at point-of-care with just one tap. This method of collecting quality data is fast and accurate, and it gives the practice real-time visibility into their quality performance throughout the year. And, probably most important to keeping our doctors happy, this saves providers and staff a significant amount of administrative work at the end of the reporting year. As the old adage goes: An ounce of prevention is worth a pound of cure. But here at pMD, we like to say that a second of prevention is worth hours of cure!

Image: Fierce Healthcare

Here's The Latest in Health Care:


•  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.

References:
http://www.cardiobrief.org/wp-content/uploads/2015/09/PhysCompProdSurvey_2015_F_SP.pdf
https://www.medaxiom.com/blog/where-cms-payment-for-quality-failed
https://morningconsult.com/opinions/hospitals-and-the-bipartisan-budget-act-of-2015/




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.