The pMD Blog

Welcome to the
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.


For years, I’ve traveled around the country, working with health care practices and organizations to improve internal processes and patient outcomes. After a recent trip to Alaska, I was pleasantly surprised that 8+ hours of travel to the “Last Frontier” allowed me to witness organizations blazing trails that left a lasting impact on how I view health care.

As the cost of health care continues to trend higher to unsustainable rates and patients are questioning if they’re actually even receiving better outcomes, there’s one state in particular that is consistently forced to acknowledge all of the above: Alaska - the state with the nation’s highest medical costs.

As I’ve been involved in working with medical software over the last 15 years, I admit that I have often gotten myopic in scope as it pertains to patients and health care. It’s become easy for me to narrow my focus on helping leverage communication, tools, and software that immediately help caretakers to get that patient well and on their way to a smooth recovery. For example, patient presents, issue is diagnosed and acutely treated, patient is released from the hospital, and hopefully on their way to recovery and healthier living.

My recent trip to Alaska had been eye-opening and shifted my paradigm on what drives the costs of health care so high. I came to find that truly owning the relationship with the patient drives better overall patient outcomes. Fragmentation of patient information and poor communication amongst providers is a key driver to higher health care costs and a serious challenge when trying to deliver positive patient outcomes. This is especially challenging in a state where it can take 14 hours to transfer a patient from one hospital to the next. At pMD, we are fortunate enough to partner with several, very innovative and patient-centric organizations in the Anchorage community that are making a significant impact.

While I was in Alaska, I heard one physician mention, “What’s most important in this day and age is that someone knows you as a patient. It’s not enough to just have data computerized in a system.”  These organizations that we’ve partnered with are leveraging software, processes, and care teams to coordinate efforts of communication and treatment across the entire patient’s pendulum of care. Social workers, nurses, and care coordinators help closely stay in touch with that patient in an effort to avoid re-admissions. They assist with follow-up appointments, navigate prescription refills, and answer general patient questions. They serve as the central hub, helping to coordinate care amongst PCPs, specialists, and the hospitals. In turn, by being proactive in this communication, they’re often able to prevent patients from returning back to the ER and hospitals.

For me, it was a light bulb moment in understanding that the best way to drive better patient outcomes, lower readmission rates, and reduce the costs of health care is to have a care team coordinate the care of at-risk patients even while they are not actively in the hospital. I’m sure we have all had that experience, amongst ourselves or a family member, leaving the hospital and feeling grossly unprepared to navigate the on-going medicines, therapies, and unforeseen symptoms that may arise after leaving. To be able to witness this coordination of care first-hand in Anchorage was easily one of my favorite and memorable customer site visits in over seven years at pMD.

As a company and partner, we are thrilled to play a part in providing software tools that link the community of Anchorage together. In turn, that community is able to organize, coordinate, and securely communicate amongst care teams and their patients to save lives and lower the cost of health care. We hope to be a partner with many other communities around the country, providing intuitive, coordinated technology that improves patient outcomes. For additional information about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

Image: Fierce Healthcare

Here's The Latest in Health Care:


•  On Thursday night, Republican Senators failed to pass the "skinny" bill, which would have said goodbye to ACA's "individual mandate." The mandate required that nearly every American have insurance or pay a penalty and was one of Obamacare's least popular provisions. Insurers, doctors, consumer advocates, and health policy experts agreed that this repeal would have wrecked the individual market.  Read More

•  Amidst the rumors that Apple is in talks with health care organizations to explore the realm of health records, reports that Amazon is considering developing an EHR platform are stirring. Amazon has reportedly started a secret lab in Seattle, its headquarters, and has a crew working on health care applications for Amazon devices.  Read More

•  How up-to-date are you on health care news? Take this fun, online quiz by The New York Times to find out!  Read More

•  While there has been significant progress in research surrounding sports-related head injuries, there is little data on women as most research participants tend to be male athletes.  The National Institutes of Health (NIH) recently began to require scientists to include female animals in brain injury studies.  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: Takao Someya/University of Tokyo

Here's The Latest in Health Care:


•  The National Institutes of Health (NIH) is working on new strategies to enroll more children in longitudinal studies that are part of their precision medicine cohort program. The All of Us Research Program aims to conduct genomic research and responsibly engage children in the decades-long studies.  Read More

•  This week, the GOP's repeal-and-delay measure lacked the votes to move forward after three Republican senators opposed the plan to repeal the Affordable Care Act (ACA). Senate Majority Leader Mitch McConnell could only afford to lose two votes on this bill. The White House said in a statement on Tuesday that it would back whichever strategy results in repealing the ACA.  Read More

•  Scientists have developed a new, wearable sensor that can monitor your body's activities. The sensor is lightweight, thin and flexible. It resembles that of a henna tattoo and can monitor vital signs over a long period of time. Researchers hope that it can monitor a patient's vital signs without any discomfort.  Read More

•  With financial incentives and penalizations in place to reduce hospital readmissions, the readmission rate declined 20 percent since its inception in 2012 under the Affordable Care Act.  Such a decline led some researchers to be concerned about unintended consequences, such as more deaths as patients are kept out of the hospital. In a study published Tuesday in the Journal of the American Medical Association, no evidence was found that the reduction in hospital readmissions resulted in more deaths.  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.

pMDers travel. We travel a lot. Whether it’s for implementations or account management, you can find us in any given city on any given week. But while racking up the miles is part of the job, each meeting we have is an opportunity to strengthen our relationships with our clients, which in turns creates opportunity for expanding our customer base. When we travel, there is not a minute where we’re not interacting with our customers or strategizing how to make our customers even happier.

So what goes into a week of travel for a pMDer? A lot! Last week, my colleagues and I set off on a business trip to visit our customers and implement two new groups. While our weeks of travel can be a whirlwind, each city we touch down in has a purpose, has a reason. Our week of travel stretched across multiple states and multiple time zones. So let’s look at the numbers in five business days:

 


What does that all mean? The miles traveled, the hours spent in the air and only three trips to a local Whole Foods gave us the best number of all: ONE happy week of customer visits! While we understand that building a successful brand is a marathon and not a sprint, our team was able to accomplish in one week what some would spread out over a few weeks. Our small and agile team was able to bring on ten providers and even more staff members to use pMD, visit multiple existing customers, and all while seeing new cities and states, sampling local libations throughout the journey! If you have any questions or would like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, and care coordination software and services, please contact pMD.

Image:  Getty Images

Here's The Latest in Health Care:


•  On Thursday, the Senate released revisions to the Better Care Reconciliation Act. The new bill makes some significant changes from the last BCRA draft but also leaves some major parts from the original proposal intact.  Some of the changes include allowing insurance premiums to be paid for using health savings accounts, more money going towards the opioid epidemic, keeping Obamacare taxes, allowing insurers to offer non-Obamacare-qualified plans and more stabilization money for high-risk customers. Proposals to cut Medicaid spending and allowing states to opt out of key parts of Obamacare remain unchanged.  Read More

•  On Tuesday, the Centers for Medicare and Medicaid Services announced that it has approved the waiver that will allow Alaska to continue its reinsurance program. The Alaska Reinsurance Program was created by the state to rescue its struggling ACA exchange and stabilize its individual marketplace. It is predicted that the reinsurance program will lower premiums by 20% and provide an additional 1,400 people with coverage.  Read More

•  You may re-think that second helping of mac and cheese when you realize what dangerous chemicals are lurking in that coveted powdered cheese mix.  Phthalates can disrupt male hormones like testosterone and have been linked to genital birth defects and behavioral problems. These chemicals were previously banned from children's toys a decade ago but may be present in high concentrations in mac and cheese powder mixes.  Read More

•  Emerging research has found that heart disease threatens women long-term who develop hypertension or diabetes during pregnancy. Women who had complications during pregnancy or labor are advised to alert their primary care physicians and screen annually for high blood pressure.  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 know you don’t want to hear this, but it’s already July. And, unfortunately, that means we’re already over 6 months into the first performance year for MIPS. Hopefully, you’re feeling more comfortable with basic MIPS requirements. If not, check out these additional blogs (here, here and here), plus our webinar. But, assuming you’ve got the basics down, you’re now probably wondering how all that reporting translates into your payment adjustment. Well, you’ve come to the right place.

No big surprise here, but MIPS scoring is extremely complicated. I’ve broken it down to the simplest explanation I can muster, but that still involves a few separate blog posts. In this post we’ll discuss the fundamentals of MIPS scoring, as it applies to registry reporting, since pMD is a CMS certified MIPS Registry. Keep an eye out for the next installations of this post, where I’ll explain each individual MIPS categories’ scoring guidelines: Quality Scoring (Part 2), Improvement Activities Scoring (Part 3), and Advancing Care Information scoring, tying it altogether with an overview of the MIPS payment adjustment calculation (Part 4).

Got it?  Then, Ready?  Set.  Go!

MIPS Scoring, Simplified: The Fundamentals  

At the end of the day, the piece of the MIPS puzzle that everyone is most interested in is the payment adjustment. The payment adjustment determines how much of your money CMS will keep and, ideally, how much additional payment you will receive from CMS. Your MIPS payment adjustment is calculated based on your MIPS final score. So, let’s start with how the final score is calculated.

What are the basic components of my MIPS Final Score?

The final score for the 2017 performance year is composed of three different categories, each of which contribute a certain percentage to the MIPS final score. Quality, which replaces PQRS, contributes 60% of the MIPS final score. Advancing Care Information, which replaces the Medicare EHR Incentive program for eligible professionals, typically contributes 25% of the MIPS final score. Finally, Improvement Activities, a brand new program from CMS, contributes 15% of the MIPS final score.

 


Image: Centers for Medicare and Medicaid Services

That means each individual category receives a score, which is then weighted and combined to get the MIPS final score. We’ll look at each individual category’s score calculation in subsequent blog posts, but for now, let’s review some other fundamental questions of MIPS scoring.

Is my payment adjustment applied to all of my billing? Or just to my Medicare Part B billing?

Even though MIPS requires that you report measures on all your patients – not just your Medicare Part B patients – your MIPS payment adjustment is only applied to your Medicare Part B billing. Phew!  

What year will my payment adjustment be applied to?

MIPS payment adjustments are applied two years after the performance period. That means that any payment adjustment you earned in the 2017 performance period will be applied to your Medicare Part B billing in 2019.

Whose billing is the payment adjustment applied to?

For MIPS, the payment adjustment will be applied to the billing of the TIN/NPI, no matter how the TIN/NPI reported data during the performance period. For registry reporting, a practitioner can report either as a group or as an individual. But, no matter which method you choose, the payment adjustment will be applied to your individual TIN/NPI’s Medicare Part B billing.

What happens if I change employers, or if my TIN dissolves?

For MIPS, the assigned payment adjustment will actually follow the NPI – no matter what TIN is associated with your NPI’s billing. This is a huge change from PQRS, and while it has concerning implications, it also closes one of PQRS’ biggest loopholes.

What if I bill under multiple TINs?

If all of your TINs participate in registry reporting, where the only two options for reporting are either individual or group, then only the highest score will be applied to the NPI. So let’s say you moonlight at a hospital that collects and submits MIPS measures on your behalf. This submission will generate one MIPS score associated with your NPI and the hospital’s TIN. If you also have a daily primary care practice, and submit MIPS measures for your private practice, you will receive a MIPS score associated with your NPI and your private practice’s TIN. For the payment adjustment, CMS will apply whichever score was higher to both TINs associated with your NPI.

Ok, now you’ve got the fundamentals down! Stay tuned for Part 2, where we’ll discuss how the Quality and Improvement Activities sections are scored. And as always, if you have any questions or would like to find out more about our MIPS registry, give us a call! To find out more about pMD's suite of products, which includes charge capture, secure messaging, and care coordination software and services, please contact pMD.

References:

  • Components of MIPS Final Score:  “We are finalizing that for the first MIPS payment year (2019), the quality performance category will account for 60 percent of the final score and the cost performance category will account for 0 percent of the final score…” See https://www.federalregister.gov/d/2016-25240/p-3803; see also Table 29 in the Final Rule https://www.federalregister.gov/d/2016-25240/p-3804; see also 2017 MIPS Performance graph at https://qpp.cms.gov/mips/quality-measures.   

  • MIPS requires reporting on all patients, not just Medicare Part B FFS patients:  “Individual MIPS eligible clinicians or groups submitting data on quality measures using QCDRs, qualified registries, or via EHR must report on at least 50 percent of the MIPS eligible clinician or group's patients that meet the measure's denominator criteria, regardless of payer for the performance period.” See https://www.federalregister.gov/d/2016-25240/p-1488

  • The MIPS payment adjustment is only applied to your Medicare Part B FFS billing:  “Specifically, MIPS payment year is defined at § 414.1305 as a calendar year in which the MIPS payment adjustment factor... are applied to Medicare Part B payments.” See https://www.federalregister.gov/d/2016-25240/p-3328

  • The MIPS payment adjustment from the 2017 performance year will be applied to 2019 billing:  “Further, we are finalizing our proposal to use performance in 2017 as the performance period for the 2019 payment adjustment. Therefore, the first performance period will start in 2017 and consist of a minimum period of any 90 continuous days during the calendar year in order for clinicians to be eligible for payment adjustment above neutral. Performance in that period of 2017 will be used to determine the 2019 payment adjustment.” See https://www.federalregister.gov/d/2016-25240/p-160.

  • Even when reporting as a group, the MIPS payment adjustment will be applied to the individual’s TIN/NPI billing:  “A TIN/NPI may receive a final score based on individual, group, or APM Entity group performance, but the MIPS payment adjustment would be applied at the TIN/NPI level.” https://www.federalregister.gov/d/2016-25240/p-3871.

  • The MIPS payment adjustment will be applied to the NPI, even if the TIN changes between the performance year and the payment year:  “[W]e are finalizing our policy to use the TIN/NPI's historical performance from the performance period associated with the MIPS payment adjustment, regardless of whether that NPI is billing under a new TIN after the performance period.” See https://www.federalregister.gov/d/2016-25240/p-3908.

  • If an NPI reports under multiple TINS, the highest score associated with the NPI will be used to determine and apply the MIPS payment adjustment:  “Therefore, we are finalizing our alternative policy to use the highest final score associated with an NPI from the performance period.” See https://www.federalregister.gov/d/2016-25240/p-3901.


Image:  Philby Illustration/Ikon Images/Getty Images

Here's The Latest in Health Care:


•  A new study reports that an increased risk of early death can be tied to proton pump inhibitors (PPIs), which are sold as common over-the-counter heartburn medication.  These PPIs have been linked to serious side effects associated with premature death.  Read More

•  The President's nomination for the next surgeon general is Indiana State Health Commissioner Jerome Adams, M.D. Adams has helped lead the charge in dealing with the state's opioid epidemic. His nomination must still be confirmed by the Senate but if appointed, he will serve a four-year term, replacing Vivek Murthy, M.D., who was fired in April.  Read More

•  If the current proposed health care bill becomes a law, it is predicted that 15 million fewer people would have Medicaid coverage by 2026. Some states have already begun to look for ways to tighten eligibility, with availability only for those who truly need it.  Read More

•  The Department of Health and Human Services is awarding $15 million for the families of Flint, Michigan affected by lead exposure. These earmarked funds will help residents who are experiencing health issues linked to the community's tainted water supply.  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: Oscar Gronner

Here's The Latest in Health Care:


•  As the number of accountable care organizations (ACOs) continue to grow this year, their success depends on how well they align with new payment models as well as off-loading some of the administrative burdens from providers. Balancing multiple advanced payment models at a time can be a challenge but is important for providers to experiment with these models and gain adequate knowledge of how they work for the benefit of their organizations.  Read More

•  The Black Plague killed a third of Europe's population 700 years ago. Today, the plague periodically re-emerges but can be treated with common antibiotics. Yersinia pestis, a flea-dwelling bacterium, is the cause of what was once known as the Black Death for the dark patches caused by bleeding under the skin. The most recent cases were reported in New Mexico, two of them this week.  Read More

•  The GOP has decided to delay the vote on their health care bill until after the July 4 holiday. At this point, Republicans are short on votes that are needed to pass the bill. Five Senate Republicans oppose the bill primarily because it defunds Planned Parenthood and cuts Medicaid funding.  Read More

•  We've all experienced that sudden jolt of crippling stomach pain or nausea at one point in our lives. Our immediate reaction is to blame the last thing we ate or drank. "It had to be the sushi," or "I knew that egg looked a little funny".  To help truly pinpoint the source of the unpleasant ailment, figuring out the correct time frame of consumption and considering the CDC's list of foods that are more likely to be contaminated are useful strategies in finding the culprit that finds us bed-ridden for a day or two.  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.

Once upon a time, not too long ago, there was a woman with diabetes named Charlie, who lived in a faraway land. Despite the beautiful wide open spaces, fresh air, and golden silence, when it came to seeking medical attention, living on the frontier was a great challenge for Charlie. Charlie never knew the gravity of her symptoms and whether or not they granted a lengthy, 4-hour drive to the hospital. Charlie isn’t the only one who faces uncertain circumstances such as these. According to Stanford Medicine, 20% of our nation’s population live in rural communities, while only less than 10% of physicians in the U.S. practice in these areas. What if Charlie could have peace of mind in the midst of her medical concerns? What if she could open up her laptop or mobile device and manage her chronic condition from the comfort of her own home? Fast forward to 2017 and this scenario is now possible and preferable with telehealth, the practice of using telecommunications technology to evaluate, diagnose, and care for patients at a distance.

Telehealth’s Reach

Telehealth provides greater accessibility to patients with transportation and location barriers and saves time and effort for the health care provider, preventing overcrowded emergency rooms and clinics. Did you know that 71% of emergency room visits are unnecessary and preventable? Many urgent but non-life-threatening conditions can effectively be diagnosed and treated remotely. Hence the reason why Blue Cross Blue Shield of Georgia, as of July 2017, will end reimbursements for non-urgent ER visits and is asking members instead to utilize the insurer’s telehealth platform. All the more reason to stay in bed.

Telehealth doesn’t just benefit people in remote areas. Take, for example, New York City folk who do not have the time to wait a few hours to be seen in a busy urgent care facility or may be too sick to even get out of bed and hop on the busy subway. Telehealth offers solutions like giving patients the ability to request a house call from a mobile app. A doctor arrives at your front door and can diagnose and even prescribe meds right at the point of care. Telehealth can also provide online psychiatric and counseling services. Having a panic attack? Instead of dealing with the attack on your own and waiting to tell the provider about it at your next appointment, seek immediate care with telehealth.

Crossing Barriers

Why hasn't telehealth exploded like any other popular technological software? The lack of understanding of telehealth reimbursement is the largest reason why practices are apprehensive to adopt. It is a common misconception that providers cannot be reimbursed for telemedicine appointments, or that it is possible but only at a reduced rate. Both of which seemingly make telemedicine economically unappealing to physicians. This is simply not the case. Currently, 30 states have mandated private payer reimbursement for delivering care for telemedicine, and many commercial payers are required by state law to reimburse for telemedicine. According to Chiron Health, “The good news is that the popularity of telemedicine is driving legislators and insurance executives toward more progressive policies regarding telemedicine. However, for now, there is a patchwork of coverage.”

Another challenge telehealth faces is the lack of direct contact between the provider and the patient. To overturn this assumption, a study found that 76% of patients would choose telehealth over human contact. People are more concerned with the access of health care rather than the need for in-person interaction.

Telehealth’s Future

In the midst of our technology-centric world, it is inevitable that telehealth will continue to permeate the world of health care, becoming a standard of care and having the capacity to reach countries otherwise not able to seek medical advice. Additionally, with the widespread use of mobile software, telehealth will encourage people who normally would not seek medical care to adopt healthier lifestyle habits. pMD continues to evolve with the ever-changing health care climate and recognizes the importance of connecting providers with their remote patients. Stay tuned for upcoming product updates as we work to further build that connection.  As the future of telehealth continues to get brighter, you might be surprised at how well you can be healed from a distance.

References:

https://mhealthintelligence.com/news/ga.-payer-pushes-telehealth-to-replace-unnecessary-er-visits
https://chironhealth.com/telemedicine/regulations/
http://hitconsultant.net/2013/03/08/survey-patients-would-choose-telehealth-over-human-contact/
https://evisit.com/future-of-telemedicine-7-trends-shaping-the-future-of-telehealth/

Image: Healthcare IT News

Here's The Latest in Health Care:


•  Four lawmakers opposed the newly released Senate health care bill. In a statement Thursday afternoon, Republican Senators Rand Paul, Ted Cruz, Mike Lee and Ron Johnson announced their opposition, stating "Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation and obtaining more information before it is brought to the floor."  Read More

•  Beef imports from Brazil have been suspended in the U.S. as of Thursday due to safety concerns. A two-year investigation by Brazil's Federal Police found that dozens of federal inspectors were accused of accepting bribes to falsify sanitary permits and allow expired meats to be sold.  Read More

•  According to a new Accenture report, artificial intelligence (AI) applications are expected to save the health care industry $150 billion over the next decade. While these AI applications lead to improvements in efficiency and precision, a few concerns to keep in mind are the challenges of balancing automation and workforce, sound organizational strategy, patient engagement and security.  Read More

•  The proposed MACRA rule released by the Centers for Medicare and Medicaid Services would make it optional for physicians to adopt upgraded EHR systems and can continue using the 2014 Edition Certified EHRs. Hospitals under the current Meaningful Use regulations, however, are still required to upgrade their systems by January 2018.  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.