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.


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.
PQRS vs MIPS, quality program differences

As March 31st looms on the horizon, we've been hard at work shepherding our PQRS Registry participants towards successful quality reporting. That means we spend a lot of time analyzing data, reviewing measure selections, and answering basic questions about the PQRS program. One consistent pattern we’ve seen is confusion between 2016’s PQRS reporting program and 2017’s MIPS Quality reporting program. It’s understandable: in 2017 MIPS Quality will completely replace PQRS. To help alleviate the confusion, I’ve gathered together 8 main differences between PQRS and the MIPS Quality program.

1. Bonus and Penalty Structure:
PQRS is a stand-alone program. In 2016, failure to satisfactorily report PQRS results in an automatic 2% penalty to your 2018 Medicare billings. But, PQRS also overlaps with a variety of other CMS programs like MAV, VM, and MU. Most of these other programs also carry their own penalty or bonus, so figuring out exactly what’s at stake for one reporting period is complicated. For 2017, CMS has attempted to streamline these various programs. The 2017 MIPS Quality program is actually one part of the bigger MIPS program. So, participants in the MIPS Quality program will only have one overall MIPS penalty or bonus, rather than separate bonuses or penalties for each distinct program.

2. Who Is Required to Report Quality Measures:
For PQRS, everyone that had submitted a bill on a patient to Medicare Part B Fee For Service in 2016 needed to report quality measures if they wanted to avoid the automatic 2% penalty. For MIPS Quality reporting, not everyone that bills Medicare Part B Fee For Service will need to report. For example, the low threshold exception exempts participants who have less than $30,000 worth of Medicare Part B Fee For Service bills, or who have less than 100 Medicare Part B Fee For Service patients. Additionally, certain types of Advanced Payment Models are exempted from MIPS Quality reporting. Finally, participation in a certain other types of Advanced Payment Models means that participants can skip MIPS reporting - including MIPS Quality reporting - altogether.

3. Reporting Time Period:
To avoid an automatic penalty in PQRS, the program required that quality measures be reported for the full performance year, January 1st to December 31st. With MIPS - at least for 2017 - participants can avoid an automatic penalty as long as they report on something for some time period. Though, participants should keep in mind that this relaxed time frame for reporting period will change in 2018 and beyond, eventually once again requiring a full year's reporting.

4. Reporting Population:
PQRS requires that participants report on at least 50% of the Medicare Part B Fee For Service patients who qualify for the chosen quality measures. MIPS requires that participants report on at least 50% of all patients who qualify for the chosen quality measures, regardless of payer.

5. Number of Quality Measures Required to Report:
PQRS requires participants to report at least 9 quality measures. MIPS requires participants to report on 6 quality measures.

6. Structure of Required Quality Measures:
PQRS requires that the quality measures participants choose to report span across 3 domains, which are like categories of effective healthcare. MIPS only requires quality measures to be reported, they do not have to be chosen from any specific categories.

7. Cross-Cutting Measures vs. Outcomes Measures:
PQRS requires that the quality measures reported by participants include one cross-cutting measure, unless a special exception applies. MIPS does not require cross-cutting measures, but rather requests that the quality measures reported by participants include one outcomes measure.

8. Measure Groups:
PQRS allowed participants to utilize measure groups reporting as an alternative way to satisfactorily report quality measures; MIPS does not allow for measure groups reporting.

And, finally, one bonus difference plus similarity...

Still a Four Letter Word, Just a Different One:
PQRS means the “Physician Quality Reporting System” and MIPS is the “Merit-Based Incentive Payment System.” Thus far, despite efforts by CMS to ease the burden of quality reporting, both programs have caused frustration, anxiety and struggle for many of those involved.

Image: Robert Hanson/Ikon Images/Getty Images

Here's The Latest in Health Care:


•  Republicans' newly unveiled health care plan is not exactly drawing confidence from health insurance leaders. Just some of the many concerns with the new ACA replacement proposal range from no mention of temporary funding for premium tax credits or cost-sharing reductions to not having a replacement in place for ACA's individual mandate, giving healthy individuals less incentive to enroll in insurance plans. Read More

•  Can design flaws really kill us? According to a recent article in the New York Times, hospitals are among the most expensive facilities to build but we may have been building them all wrong. From housing patients too closely together for too long to poorly lit areas and poorly designed bathrooms causing many falls to too much exposure to noise, patients are surrounded by many factors that could potentially be life-threatening in a place that is meant to save lives. One idea to improve hospital design? More exposure to nature! Read More

•  The age of nursing homes may be transitioning to home health care with the slew of new technology available to aging patients. The existence of a "community of care" is in the near future as more of patients' data are shared with their family, health care team and even their neighbors. While all these data points raise the question of liability and privacy, some companies are more aimed towards creating new systems to help providers navigate the plethora of incoming data. Read More

•  While a handful of non-profit organizations are popping up to promote low-cost to free heart screenings for teens, disadvantages surrounding electrocardiograms (EKGs) for adolescents could far outweigh the benefits.  For one, there is no evidence that EKGs for young adults can prevent deaths, especially since sudden cardiac death is rare in young people. False positives can lead to follow-up tests and risky, unnecessary interventions. 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:


•  The unintended consequences of a gluten-free diet? Increased blood levels of arsenic and mercury, apparently. While everyone has some trace amount of arsenic and mercury in their blood, those on a gluten-free diet tend to have higher than average levels due to eating many rice-based products. Rice, it turns out, absorbs metals from water and soil.  While the health impacts at these levels are still unknown, it's good to keep in mind how much more rice gluten-free eaters are potentially consuming.  Read More

•  In an age where technology is ever prevalent in the health care setting, clinicians are often bombarded with daily alerts and alarms, causing alert fatigue and proving ineffective from its intended use. Dr. Vitaly Herasevich of the Mayo Clinic proposes a smart system to be put in place in order to curb this phenomenon. The idea is to issue alerts only in a situation when clinical providers fail to do the intended action as opposed to a reminder-like alert. This approach decreases unnecessary alerts while easing cognitive overload.  Read More

•  Trump's nomination for head of the Centers for Medicare & Medicaid Services (CMS) faced ethics questions this Thursday after nearly 3 hours of questioning during her confirmation hearings. Democrats raised ethics questions about Seema Verma's consulting firm and whether the work she did there conflicted with her public duties in Indiana.  Read More

•  New studies have found that vitamin D helps reduce the risk of respiratory infections, including colds and flu, especially in those who are vitamin D deficient. However, not everyone is convinced that we should all be heading to the supplement aisle. If you're already getting the recommended daily dose of vitamin D from your diet, a supplement may not lead to any further benefit.  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.

“Unbelievable.” “Miraculous.” “Greatest catch of all time.” These are all words and phrases to describe one particular play from this past Super Bowl. If you were one of the 111 million people watching the football game, you definitely remember this one specific play by the New England Patriots. The end of the game was quickly approaching with only 2 minutes and 28 seconds left in the game, and the Patriots were down by 8 points. In that moment, Patriots’ receiver, Julian Edelman, made one of the most memorable catches in all of football history. The odds were not in his favor as it looked like time would expire on the Patriots before they would have a chance to come back against the Atlanta Falcons. However, Julian Edelman had different plans in mind when he made an incredible catch in the last few minutes of the game to help lead a push to victory for the New England Patriots in what looked like a lost cause only minutes earlier.

So how does this epic catch relate? As the reporting deadline for CMS’s PQRS program is rapidly approaching, I’ve been speaking with many physicians and practice administrators around the country. What I’m hearing is the same sense of desperation that the New England Patriots and fans must have been feeling during the Super Bowl as their team was facing an insurmountable deficit with very little time left.

The physicians and practice administrators feel as if they need a miraculous event to save them from a 2 - 6% negative adjustment to their Medicare reimbursement in 2018. Many of these practices have had unfortunate situations where a PQRS registry was full, they were unable to follow through on successful reporting, or they simply had poor communication and planning which led to a scramble late in the 4th quarter.

I hear sentiments of anxiety, frustration, exhaustion and feelings of giving up as physicians and practices know they are almost out of time. However, as the New England Patriots can attest, “almost out of time” and “out of time” are two very different things! If you’re in a situation where you have not submitted your PQRS data for 2016, there is still time to make that game-changing diving catch to finish strong. pMD is a CMS qualified PQRS registry, and we would be happy to see if we can help. We’re accepting customers through February 28, 2017 and there is still time to work with a member of our PQRS team for a consultation and be able to submit your data to CMS to avoid the looming negative adjustment in 2018. Don’t throw in the towel!

415-422-9578
sales@pmd.com