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MACRA Insights from Around the Twittersphere – MACRA Monday

Posted on May 8, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

For this week’s MACRA Monday, I thought I’d offer some insights and perspectives on MACRA from around the Twittersphere. There’s a lot of information about MACRA shared on Twitter and here are some of the best ones I found.


I admit that I’d never heard of BKDHelathcare before, but this 2 minute video offers some good insights into the MACRA decision making process.


SA Ignite is one of the top companies working on MACRA reporting tools. So, it’s no surprise that they’re producing some great content on how to approach MACRA, MIPS and APMs. I hadn’t thought about tracking MIPS even if you’re in an APM, but SA Ignite offers a number of good reasons why organizations might want to consider doing both.


I love a good infographic. We’ve covered most of this in MACRA Monday, but this might be useful for those of you who are just catching up with the details.


The above is a politically correct plea from a doctor. There are other pleas that are a little stronger:


and…

Unfortunately, the rebel forces currently aren’t large enough to move the needle. We’ll be watching to see if that changes.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Myth: Healthcare Is Different From Other Industries

Posted on May 5, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you don’t follow David Chou on Twitter, then you’re missing out on some really great content. This is particularly true if you’re a healthcare leader. A good example of this was the following tweet that David shared:

The topic of whether healthcare is different from other industries is an important one that’s worth discussing. The chart above and the research by McKinsey&Company would suggest that healthcare isn’t all that different from other industries. However, I think there’s a nuance in their reality check.

The nuance is that healthcare have similar expectations of healthcare as they do with other non-healthcare companies. However, that doesn’t assume that healthcare consumers act the same as they do in other industries.

There are great examples of this. When you’re in the back of an ambulance after a heart attack, you’re not acting like much of a consumer. They’re taking you to the hospital of their choice and you’re going to largely get the care that the ED feels you need. In what other industry does this occur? There are other examples like elective procedures in healthcare that are very much an experience like other industries.

What the study illustrated above does teach us is that even if the consumer decision making process in healthcare is different, there are core expectations that we have regardless of how we chose to interact with the healthcare system or not. There are some universal tenants and expectations that healthcare should remember:

  • Providing great customer service
  • Delivering on expectations
  • Making life easier
  • Offering great value

I’ve started to see more and more healthcare organizations worry about these tenants of a great patient experience. When you see it broken out like the above, it sounds so simple. Implementing the ideas can be amazingly tricky. However, this is exactly where I see healthcare headed.

EHRs Were Never Designed to Influence Medicine

Posted on May 4, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This is a concept I’ve been chewing on for a couple years. When you look at the history of EHR software, EHRs were not designed to influence medicine. They weren’t designed to improve care. They weren’t designed to ensure patient safety. Looking back, they were designed as big billing and documentation engines.

When you look at their feature sets, this becomes abundantly clear. EHRs were designed to better help a practice document the visit and bill the insurance company. The idea of improving patient care, better patient safety and other ideas came along much later.

As I mentioned, I’ve written about this idea before. Usually, I proceed to talk about how doctors and practices that expect their EHR to improve care have been misled. I still think that’s largely the case and that expectations need to be adjusted. However, today I realized that there’s another important lesson that needs to be learned by the history of EHR software and that lesson is for EHR vendors.

EHR vendors need to realize that their systems weren’t designed to improve care. Write as many blog posts as you want. Add whatever signage you want to your exhibit hall booth or to your email campaigns. You still weren’t designed to improve care. This is not necessarily a bad thing, but it’s important that a company knows who it is and knows its limitations.

Think about how valuable it would be for an EHR vendor to come to this realization. Once they realize this to be the case, then their approach to working with other companies would shift dramatically. Instead of seeing other companies that do improve patient care as the enemy, they could see them as partners that could enable their EHR users to improve care. That’s right. An EHR software doesn’t have to be the end all be all.

Even if your EHR software can improve care in a few ways, this concept still applies. An EHR vendor has limited bandwidth. They can’t do everything and so they can’t improve care across every medical specialty and every opportunity. Even within a specialty, there are often innovations that other companies can provide that the EHR vendor doesn’t have time, expertise, knowledge, or capability to provide. This is why an EHR vendor that has amazing partner relationships is going to be so valuable moving forward.

I actually only know one EHR company that was truly started to modernize medicine. However, even they can’t do everything. Every EHR vendor will have to rely on partners if they really want to influence medicine the way they could and the way they should.

Various Medical Practice Model Types

Posted on May 3, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The EHR vendor (and many other services), Kareo, has put out a practice model guide which they call “Practice Models: The ABCs from ACOs to Concierge and Everything in Between.” With this guide they shared this picture that includes various practice models:

When I see an image like this I’m torn on if this is an extremely exciting time for physicians or if it’s a miserable time to be a physician. One thing is clear, times are a changing. The medical practice models of the past are going to be blown up by new models.

Take for example Telemedicine. Can you imagine any healthcare future where telemedicine is not part of that future? I can’t.

I’m still personally torn on concierge practices. I can see why they’re appealing to so many. I love the idea of unlimited primary care and getting insurance out of primary care. However, it’s not clear to me that this idea can scale across the entire healthcare system. Certainly the rich can do it no problem. Can the concierge model work for the middle and lower class? Many fans of concierge tell me it can. I’m still not so sure.

I know a lot of doctors that are part of ACOs. I don’t know very many that are excited by the work ACOs are doing. Most of them just feel like they need to be part of it to understand the future of medicine. They’re not joining ACOs because they think it’s something that shows a lot of promise for their patients.

I’m probably coming off a little more cynical than I am about these shifts. A number of these changes are really exciting to see happening. However, I’m also not blind to the challenges that many of these medical practice models face.

Needless to say, it’s an exciting and challenging time to be in medicine. The structure of how we pay for healthcare is being questioned and new models are being explored. This can be really exciting if you find yourself tracking the right wave. However, if you miss the wave, then you can be stuck out in the middle of the ocean wondering how you missed out.

Is It Time To Divorce Your HIT Vendor?

Posted on May 2, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Few organizations are totally satisfied with their technology vendors. Even if they’re doing their best, their relationship with you can be disrupted by issues like staff turnover, changes in the product roadmap or an acquisition. Depending on how well your partnership worked in the first place – and how dependent you are on their technology – you may choose to ride out such issues.

But there are times that you have to make some hard decisions about your future with a vendor, particularly if their overall strategy diverges from yours. If you’re wondering how to sort out whether you need to part ways, you might want to consider some suggestions from Dick Taylor, MD, executive vice president with healthcare IT consulting firm MedSys Group. Dr. Taylor’s “Signs Your Vendor’s Not That Into You” include:

  • The new upgrade comes with sticker shock: If the new software calls for a costly “forklift upgrade,” and all told will create a lot of expense and issues, be concerned.
  • Their technology is very dated: If the vendor hasn’t adopted current technologies like virtualization, web services and the cloud – or at least considered whether they’re appropriate for customer needs — it’s a bad sign. Remember that part of your maintenance fees should go to long-term planning by the vendor that incorporates emerging tech as needed.
  • They haven’t stayed in touch post-sale: Expect for not only sales people to touch base, but also experts from R&D, support engineering and implementation to check in and ask about your needs and concerns. If they don’t, maybe they just see you as a revenue stream.
  • Their engineering staff has been gutted: Some vendors reduce their engineering roster, particularly if they’ve acquired the product in question, seemingly in the belief that their source code will maintain itself. This will not end well.
  • They don’t have customers like you on board anymore: You don’t want to be part of a dying customer base. In fact, you want to make sure other customers like you – such as, say, other large health systems – are still part of the mix. Otherwise, it’s unlikely developers will address your specific interests.
  • They’ve lost their focus: Given the rapid pace at which new healthcare technologies emerge, it’s easy for vendors to get distracted. Of course, it’s all well and good that they’re aware of cutting-edge technologies. That being said, make sure they don’t plan to rush in a new direction and ignore your needs.

Other vendor warning signs that came to mind for me included:

  • They don’t respond promptly to service requests
  • The people who interact with you are rude or poorly trained
  • Their new contract has hidden “gotchas” in it that they won’t consider addressing
  • The product can no longer do the job for which you acquired it, and they don’t seem capable of fixing it to your satisfaction

In some ways, important vendor relationship are like marriages in that every situation is different and that some give and take is involved. But if your relationship isn’t working, or undermining your plans, you’ve probably reached the end of the road.

MACRA Burnout – MACRA Monday

Posted on May 1, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

It’s May 2017 and I’m already burnt out of MACRA. Does anyone else feel this way? The MACRA program has just gotten started and I’m already pretty sick and tired of talking about the details. I can only imagine how a doctor feels at this point. It feels a little bit like groundhog day doesn’t it?

I’m sure much of what contributes to this is the layers and layers of government requirements that we’ve had to go through over the past 5-6 years. It started with meaningful use and PQRS and then we realized there were multiple stages of meaningful use. We’ve been through stage 1 and stage 2. Of course, related to that is all the EHR certification regulation. Then, ICD-10 hit us upside the head. We worked through it, but it wasn’t fun and didn’t add much value to our patients or our organizations. Now we’re hit by MACRA. Aren’t we all just a little tired of these regulations?

Don’t get me wrong. Healthcare is a highly regulated industry, so this is the norm. Plus, I’m not saying that practices should just shun MACRA. Most practices I know need to at least avoid the penalties. So, they’ll have to participate, but I don’t know a single doctor that’s excited about the benefits of any piece of the MACRA legislation. That should tell us something and we should listen.

Think about what an achievement that is by MACRA. Doctors aren’t excited about any of it. It’s actually kind of embarrassing to think about. If you are a doctor that’s excited about some piece of MACRA and especially MIPS, I’d love to hear about it. How is any of it going to improve care, lower costs, or improve productivity? I’ll be waiting in the comments, but I certainly won’t be holding my breathe.

How sad that millions of dollars and millions of hours are going to be wasted on a legislation that isn’t too hard, but also doesn’t add value. That’s a travesty and I don’t see it changing.

I’m trying to think what would reinvigorate organizations. Is there a legislation that doctors would get excited about? That’s a hard thing to crack, but the best I could do is interoperability. What if we scraped all of MACRA and just focused on penalizing organizations that aren’t sharing data with each other.

Even this change would leave a lot of people wondering the exact value. However, there’s a pretty solid case to be made that exchanging healthcare data could improve care and lower costs. Those are things that people can get behind.

All of this said, I’m not expecting any changes. MACRA is here to stay and EHR vendors and healthcare organizations are going to have to grind it out and participate. However, that doesn’t make the MACRA burnout any less poignant.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

JCAHO Parody Video – Fun Friday

Posted on April 28, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday, so time for a little humor. Every week we could likely choose one of ZDoggMD‘s videos. Ever since he lost his job running a clinic, he’s been on a tear creating healthcare videos. What else is a doctor with no clinic going to do when he’s in Vegas? Now we know the answer.

I could have chosen a ton of different videos, but I think this one is going to really hit home with a lot of people who’ve had to deal with JCAHO in their organization.

Here are two lines from the video which made us laugh the most:

“JCAHO, I wrote an entire note, using only poo emojis”

and

“I got an email from a lovely gentleman, who was a Nigerian prince…Having some financial difficulties…And I gave him my EHR password.”

Only ZDoggMD!

Docs Are Tired of Being Force Fed IT That Makes Things Worse

Posted on April 27, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When I look at the world of healthcare IT and EHR, there are a lot of things to be proud about. In the 11+ years that I’ve been blogging about EHR, I’ve seen a massive progression in the use of technology in healthcare. I know a lot of doctors that implemented EHR the right way and are seeing a lot of value from it. It makes their workflow more efficient and helps them take care of their patients better. They can’t imagine practicing medicine without an EHR and other technology.

On the other hand, I know even more people that feel like they were force fed technology that ended up making their practice worse. I don’t want to absolve the practice of any responsibility since they chose to chase the government money and/or they kicked their heels in and made the EHR implementation as miserable as possible since they were against it in the first place. Both situations usually ended up with things getting worse for the doctor.

While those at ONC proudly proclaimed that EHR adoption was going through the roof (and it was), they essentially burned out a whole generation of physicians on the value technology could bring to their practice. In many ways, MACRA is doubling down on these same things.

I wish that every government health IT program had one requirement tied to it. Does this improve patient care or improve efficiency? If they can answer this question affirmatively with proven facts, then they should regulate, incentivize and legislate it. If it doesn’t or we don’t know, then they should do the work required to find out.

I don’t know a single doctor that when shown the evidence of the benefits to their patients and their practices doesn’t want to adopt technology. If we’d given them the time to evaluate EHR properly, learn from their peers, and implement EHR in a rationale way, most doctors would love their EHR and be happy to use it.

The challenge is where do we go from here. The damage of rushed EHR implementations is done. However, we should choose to stop doubling down on requirements that don’t improve safety, quality, and efficiency. Implementations will improve and EHR satisfaction will improve if we just stop trying to force feed doctors.

Collaborating With Patients On Visit Agendas Improves Communication

Posted on April 26, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Maybe it’s because I spent many years as a reporter, but when I meet with a doctor I get all of my questions out, even if I don’t plan things out in advance. I realize that this barrage may be unnerving for some doctors, but if I need to fire off a bunch of questions to understand my care, I’m going to do it.

That being said, I realize most people are more like my family members. Both my husband and my mother feel overwhelmed at medical visits, and often fail to ask the questions they want answered. I don’t know if they feel pressured by the rapid pace of your typical medical visit, afraid to offend their doctor or have trouble figuring out what information will help them most effectively, but clearly, they don’t feel in control of the situation.

Given their concerns, I wasn’t surprised to learn that letting patients create and share an agenda for their medical visit – before they see their provider – seems to improve physician-patient communication substantially. New research suggests that when patients set the agenda for their visit, both the patient and their doctor like the results.

Study details

The paper, which appeared in the Annals of Family Medicine, said that researchers conducted their study at Harborview Medical Center, a safety-net county hospital in Seattle. The researchers recruited patients and clinicians for the study between June 9 and July 22, 2015 at the HMC Adult Medicine Clinic. The 67-clinician primary care clinic serves about 5,000 patients per year.

When participating patients came in for a visit, a researcher assistant met them in the waiting room and gave them a laptop computer with the EMR interface displayed. The participating patients then typed their agenda for the visit in the progress notes section of their medical record. Clinicians then reviewed that agenda, either before entering the exam room or upon entering.

After the visit, patients were given a survey asking them for demographic information, self-reported health status and perceptions of the agenda-driven visit. Meanwhile, clinicians filled out a separate survey asking them for their gender, age, role in the clinic and their own perceptions of the patient agenda.

After reviewing the survey data, researchers concluded that using a collaborative visit agenda is probably a good idea. Seventy nine percent of patients and 74 percent of clinicians felt the agendas improved patient-clinician communication, and both types of participants wanted to use visit agendas agenda (73 percent of patients and 82 percent of clinicians).

Flawed but still valuable

In closing, the authors admitted that the study had its technical limits, including the use of a small convenient sample at a single clinic with no comparison group, It’s also worth noting that the study drew from a vulnerable population which might not be representative of most healthcare consumers.

Nonetheless, researchers feel these data points to a broader trend, in which patients have become increasingly comfortable with electronic health data. “The patient cogeneration of visit notes, facilitated by new EMR functionality, reflects a shift in the authorship and “ownership” of [their data],” the study points out. (I can’t help but agree that this is the case, and moreover, that patients’ response to programs  like Open Notes support their conclusion.)

I’m not sure if my mom or hubby would buy into this approach, but I imagine that if they did, they might find it helpful. Let’s hope the idea catches fire, and helps ordinary consumers take more control of their clinical relationships.

Could AI And Healthcare Chatbots Help Clinicians Communicate With Patients?

Posted on April 25, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

AI-driven chatbots are becoming increasingly popular for a number of reasons, including improving technology and a need to automate some routine processes. (I’d also argue that these models are emerging because millennials and Gen Z-ers have spent their lives immersed in online-based social environments, and are far less likely to be afraid of or uncomfortable with such things.)

Given the maturation of the technology, I’m not surprised to see a number of AI-driven chatbots for healthcare emerging.  Some of these merely capture symptoms, such as the diabetes, CHF and mental health monitoring options by Sense.ly.

But other AI-based chatbots attempt to go much further. One emerging company, X2ai, is rolling out a psychology-oriented chatbot offering mental health counseling, Another, UK-based startup Babylon Health, offers a text-only mobile apps which provides medical evaluations and screenings. The app is being pilot-tested with the National Health Service, where early reports say that it’s diagnosing and triaging patients successfully.

One area I haven’t seen explored, though, is using a chatbot to help doctors handle routine communications with patients. Such an app could not only triage patients, as with the NHS example, but also respond to routine email messages.

Scheduling and administration

The reality is that while doctors and nurses are used to screening patients via telephone, they’re afraid of being swamped by tons of electronic patient messages. Many feel that if they agree to respond to patient email messages via a patient portal, they’ll spend too much time doing so. With most already time-starved, it’s not surprising that they’re worried about this.

But a combination of AI and healthcare chatbot technology could reduce their time required to engage patients. In fact, the right solution could address a few medical practice workflow issues at one time.

First, it could triage and route patient concerns to doctors and advanced practice nurses, something that’s done now by unqualified clerks or extremely busy nurses. For example, the patient would be able to tell the chatbot why they wanted to schedule a visit, with the chatbot teasing out some nuances in their situation. Then, the chatbot could kick the information over to the patient’s provider, who could, with a few clicks, forward a request to schedule either an urgent or standard consult.

Perhaps just as important, the AI technology could sit atop messages sent between provider and patient. If the patient message asked a routine question – such as when their test results would be ready – the system could bounce back a templated message stating, for instance, that test results typically take five business days to post on the patient portal. It could also send templated responses to requests for medical records, questions about doctor availability or types of insurance accepted and so on.

Diagnosis and triage

Meanwhile, if the AI concludes that the patient has a health concern to address, it could send back a link to the chatbot, which would ask pertinent questions and send the responses to the treating clinician. At that point, if things look questionable, the doctor might choose to intervene with their own email message or phone call.

Of course, providers will probably be worried about relying on a chatbot for patient triage, especially the legal consequences if the bot misses something important. But over time, if health chatbot pilots like the UK example offer good results, they may eventually be ready to give this approach a shot.

Also, patients may be uncertain about working with a chatbot at first. But if physicians stress that they’re not trying put them off, but rather, to save time so they can take their time when patients need them, I think they’ll be satisfied.

I admit that under ideal circumstances, clinicians would have more time to communicate with patients directly. But the truth is, they simply don’t, and pressuring them to take phone calls or respond to every online message from patients won’t work.

Besides, as providers work to prepare for value-based care, they’ll need not only physician extenders, but physician extender-extenders like chatbots to engage patients and keep track of their needs. So let’s give them a shot.