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Call to Halt ICD-10 Puts New Angle on Demand for Physicians

Posted on January 12, 2013 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

The American Medical Association’s most recent call to halt implementation of ICD-10 codes brings to light an interesting angle to the coding story – one that I hadn’t recognized until I read up on just why the AMA has consistently made it known that the switch is a bad idea.

The association believes transitioning to the new, 68,000 codes will place too much of a financial and administrative burden on physicians (especially small practices), and will ultimately force many of them to shut their doors.

Attending education sessions at AHIMA last fall left me with the impression that though learning the new codes and suffering through dual coding wouldn’t be fun, they would ultimately help physicians and hospitals receive proper reimbursement for their services. Yes, there were vendor cheerleaders on many panels, but the logic made sense even to a novice like me.

I realize that physician practices are quite a different kind of beast when it comes to handling administrative tasks, and I can certainly understand how a small practice would feel completely overwhelmed when, as the AMA stated in a letter to CMS, overlapping federal regulations combined with predicted Medicare pay cuts will make switching to ICD-10 a huge difficulty for them.

But I feel as if there’s a catch 22 here. If physicians don’t make the switch, they won’t see the potential financial benefits of more accurate coding. If they do make the switch, they’ll likely face such huge financial strains that they’ll opt to go out of business. Are there any physician readers out there who are cheerleading the ICD-10 switch?

It occurred to me, reading recently about the predicted banner year for physicians seeking hospital employment, that physicians that do decide to close their doors as a result of ICD-10 may contribute to this glut of MDs looking for work.

Perhaps there’s a domino effect waiting to happen – CMS stands firm on the ICD-10 deadline / Physicians work incredibly hard to try and make it happen. / Physicians fail and go out of business, or decide early on that it’s just not worth the trouble and close up shop. / Said physicians seek hospital employment. / There aren’t enough hospital jobs to go around and many MDs are left in the unemployment line.

That’s just one scenario I’ve been mulling over, and of course doesn’t take into consideration the large amount of other challenges facing physicians right now. What’s your take on the ICD-10 and physician staffing situation?

Cutting EMR Training Budget Can Create Serious Problems

Posted on April 17, 2012 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 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.

Not long ago, American Medical News ran an article on training up medical practice staffers for EMR use. The piece concluded that while practices may save some bucks on the front end, they generally end up regretting it later.  An anecdote from the piece:

Nine months after All Island Gastroenterology and Liver Associates in Malverne, N.Y., went live with its electronic medical record system, practice administrator Michaela Faella realized things had not gone as smoothly as planned.

Even though the staff had used other health information technology systems for many years and considered itself tech-savvy, it had taken everyone six months to learn how to use the new EMR system. Several months later, the staff still had not become proficient at it.

The problem was not with the staff, but that the practice cut training short to save time and money. “Training was not placed high on the priority list, and we paid the price for it,” Faella said.

As the piece notes, many practices assume that the training bundled into the cost of their new EMR will meet their needs, and find out to their regret that this isn’t the case.  (In fact, I’d argue that this is more the rule than the exception, based on anecdotes I hear in the field and in conversations with physicians.)

A consultant quoted in the piece suggests that practices should consider three main issues when planning for training:

1) How much data they’ll be dealing with, which can vary greatly depending on whether all data is imported in advance or done patient by patient

2) Whether the practice will be integrating new systems into the EMR, such as e-prescribing, or conversely, adding an EMR to existing systems

3) Whether using the EMR will call for using new hardware such as tablet computers

Personally, I’m not satisfied by that list at all.

What about, first and foremost, assessing the staff’s existing skills more precisely, walking staffers through the various layers of the EMR on a daily basis, forming teams of superusers within the organization to help the less skilled and taking steps to be sure EMR problems don’t interrupt critical functions (a backup/workaround plan for the short term)?

What do you think?  Does the list above cover the critical EMR practice integration issues?  Am I just being testy?

Is This Failure Really Necessary? Another HIE Closes Its Doors

Posted on July 22, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

For several years, I’ve been watching health information exchanges struggle to birth themselves. Despite ongoing support from state and local governments, HIEs continue to fade away, few having found a business model that works. And no workable business model seems to be on the horizon yet, either, despite efforts by thousands of providers to keep their HIE afloat.

This week, I was sorry to read about the death of yet another HIE.  CareSpark, a Kingsport, TN-based network which has been in existence for six years, announced on July 11th that it would be ceasing operations.  CareSpark, whose age makes it almost a young adult in HIE years, holds records for 1.28 million patients.

According to a piece in FierceHealthIT, CareSpark was forced to close because it couldn’t come up with a viable plan to sustain itself.  The group’s leaders had hoped to move from a grant-supported non-profit to one-funded by payments from subscribers, but apparently, they just couldn’t attract enough cash to survive.

The group began its final descent in March, when Health Information Partnership of Tennessee pulled federal funding from CareSpark.  The closing leaves 38 participating healthcare organizations in the lurch.

Given you don’t have a mature EMR if you can share health information freely — at least according to HIMSS Analytics — you’d think that providers would finally be ready to dish out enough money to support their local HIE.  But apparently, they aren’t.

The question is, why?  Do hospitals and medical practices think of HIEs as “nice to have” rather than “need to have”?  Do providers only kick in money when they can control the whole exchange (such as linking up hospitals within a single chain)? Have any of them done a cost/benefit analysis which suggests HIEs *aren’t* a good investment?

All I know is that if 38 providers spend six years building up trust, it doesn’t make much sense to cheap out now, especially if it shuts down critical linkages between their EMRs. I’d really like to know why they don’t want to pay for this. Don’t you? After all, it’s about time we figure out what kind of HIE model does work.

Is There An Alternative To The RECs?

Posted on July 10, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A few days ago, I wrote a column for sister blog EMRandHIPAA dishing out scathing criticism of the Regional Extension Center (REC) program.

Not one to mince words, I confess I was a bit merciless in my critique, slamming the RECs as virtually useless. (Yes, I’m sure they’ve had the occasional success, but far too few to justify their existence  — or so it seems from my vantage point.)  The column smoked out a few REC defenders, but most  people who commented seemed to share my frustration.

All that being said, it’s hard to argue that there’s a place for organizations that intelligently, efficiently offer EMR adoption help to smaller medical practices.  It’s all well and good to push hospitals and other institutions to go digital, but doctors are where the rubber hits the road.

So after heaping abuse on the RECs — your call as to whether I’ve been fair — I thought it might be worthwhile to offer a few alternative approaches (which could be offered singly or as a package):

* Small practices usually can’t afford top-drawer IT consultants to guide them in EMR adoption. What if the REC program existed entirely to help practices assess their workflow and clinical needs? The consultants, which could be made available for free or for a small fee, would come on site and teach practices how to think about these problems.

* The RECs could offer a very rich Web resource, including checklists and forms, helping practices create lists of automatically-generated criteria and matching those results to EMR products. Once the matching process was complete, RECs could offer phone-based or live sessions helping doctors understand how to effectively research those vendors.

* What if RECs offered intense EMR education classes, as some professional societies are beginning to do, which physician leaders could attend to gain a broader view of both business problems and technology issues.  Ideally, the classes would come with CME credits, which would definitely encourage more doctors to attend.

So, these are just a few ideas that popped into my head as I composed this article. I’d love to hear your thoughts. What services should a REC or similar organization offer to advance EMR adoption?

Who Are You Leaving Out Of Your EMR Plans?

Posted on April 11, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As any reader of this blog knows, it takes a lot of consensus building to successfully implement an EMR, whether you’re rolling it out across a large health system or within a small medical practice.

The thing is, I get the sense that many of the day-to-day staffers who will have to live with the EMR system aren’t consulted during the acquisition process, or only at best, only get to participate late in the game.

I’ll remind readers up front that I’m a journalist, not an EMR consultant, but from what I’ve seen, the following healthcare professionals seldom get much input into EMR decision-making:

– Front-line nurses

– Nurse managers

– Billing managers

– Coding professionals

– Medical practice managers

– Day-to-day IT support staff

– Medical assistants

While admittedly, some of these players play a more central role in patient care than others, they all have a window into what the EMR should deliver.  And if you asked them to review the vendor demo, examine the features and pose some questions, they might find issues that you hadn’t anticipated.

They might also note process problems that you weren’t aware of which, even if they can’t be solved by the EMR itself, may never come up for discussion during the normal course of business.

All told, my sense is that if a hospital or medical practice circulated questionnaires asking a broad range of staffers what the EMR should do, and what’s not working in the current environment, they’d make better decisions and learn a lot about their organizations along the way.

Unfortunately, I doubt this will happen much, as healthcare is still lamentably hierarchical and riddled with inefficient top-down decision making. But hey, the idea’s worth a mention…

Do You Need An EMR To Make ACOs Work?

Posted on February 28, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Right now, as things stand, only a small percentage of medical practices have fully implemented EMRs (about 15 percent), research suggests.  But the trend toward integrating physicians in Accountable Care Organizations is moving much faster.

I don’t have stats to hand, but everything I’ve read and heard suggests that the provider community is a lot more comfortable with the ACO concept than EMR adoption.

The thing is, can ACOs advance without higher EMR adoption rates?  I don’t think so.  To my mind, if you want to integrate medical practices and hospitals — with the goal of managing quality jointly — a shared EMR seems virtually indispensable.

During the first wave of ACO adoption, we’re seeing tie-ups between mid-sized to large practices and large health systems.  Those large practices are reasonably likely to have EMR systems in place, and just as importantly, an IT department to support them.

But if ACOs models are to work, they’ll eventually have to embrace smaller practices, which make up the vast majority of U.S. medical groups overall. And if those groups are either EMR-less or just getting started, it’s going to be pretty tough to share value-based payments, coordinate across episodes of care and track quality jointly.

Yes, hospitals can give doctors access to their own, industrial-grade EMRs — and some do — but ultimately, EMR use will have to be part of the smaller practices’ culture for ACOs to work.

And while medical practices will understand ACOs, particularly if they’ve been through lots of fashionable hospital-practice partnership models, EMRs will still be tough to swallow.

So, ACO backers, do you think you can move ahead if your physician partners aren’t EMR-connected and savvy?  Or are we looking at a big problem here?