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MGMA Blames Rise in HIT Costs on Fed’s Regs

Posted on September 15, 2016 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

MGMA’s released a study of 850 member’s practices showing HIT costs up by more than 45 percent in the last six years. MGMA puts much of the blame on federal regulations. It’s concerned that:

Too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing better patient care. Unless we see significant changes in the final MIPS/APM rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.

There may be a good case that the HITECH act is responsible for the lion’s share of HIT growth for these and other providers, but MGMA study doesn’t make the case – not by far.

What the study does do is track the rise in HIT costs since 2011 for physician owned, multispecialty practices. For example, MGMA’s press release notes that IT costs have gone up by almost 47 percent since 2009.

In fairness, MGMA also notes that costs may have also gone up do to other costs, such as patient portals, etc. However, the release emphasizes that regulations are at great fault.

Here’s why MGMA’s case falls flat:

  • Seeing Behind the Paywall. If you want to examine the study, it’ll cost you $655 to read it. Many similar studies that charge, provide a good synopsis and spell out their methodology. MGMA doesn’t do either.
  • Identifying the Issue. It’s one thing to complain about regulations. It’s quite another to identify which ones specifically harm productivity without compensating benefit. MGMA cites regulations without so much as an example.
  • Lacking Comparables. MGMA’s press release notes that total HIT costs were $32,000 per practitioner. However, this does not look at non HIT support costs, nor does it address comparable support costs from other professions.
  • Breaking Down Costs. The study offers comparable information to practitioners by specialty types, etc. However, all IT costs are lumped together and called HIT.
  • Ignoring Backgrounds. MGMA notes that HIT costs rose most dramatically between 2010 and 2011, which marked MU1’s advent. It doesn’t address these practices’ IT state in 2009. It would be good to know how many were ready to install an EHR and how many had to make basic IT improvements?
  • Finessing Productivity. Other than mentioning patient portals, MGMA ignores any productivity changes due to HIT. For example, how long did it take and what did it cost to do a refill request before HIT and now? This and similar productivity measures could give a good view of HIT’s impact.

It’s popular to beat up on HITs in general and EHRs in general. Lord knows, EHRs have their problems, but many of the ills laid at their doorstep are just so much piling on. Or, as is this case, are used to make a connection for the sake of political argument.

Studies that want to get at the effect HIE and EHRs have had on the practice of medicine need to be carefully done. They need to look at how things were done, what they could accomplish and what costs were before and after HIT changes. Otherwise, the study’s data are fitted to the conclusions not the other way around.

MGMA’s a major and important player with a record of service to its members. In this case, it’s using its access to important practice information in support of an antiregulatory policy goal rather than to help determine HIT’s real status.

Working on Value Based Care and Fee For Service at the Same Time

Posted on November 2, 2015 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.

While at MGMA I had a chance to sit down with Mike Hofmeister, Vice President of Value-Based & Community Solutions at Allscripts, to talk about Allscripts’ Chronic Care Management (CCM) and other value based care efforts. Coming out of MGMA I’d say that Chronic Care Management (CCM) was one of the biggest topics people were talking about.

What’s a bit unique about CCM is that it’s a hybrid of value based care in a fee for service world. In fact, when I asked Mike about how Allscripts was balancing value based care with fee for service he told me that they were looking at opportunities to implement processes, procedures, and workflows that benefited both value based care and fee for service.

I found this to be an incredible insight into the path forward for those of us trying to figure out how to navigate this new value based reimbursement world. No doubt there are plenty of efforts that can satisfy both sides of the equation. The reality is that we can’t just flip the value based care switch on and the fee for service switch off. We’re going to be living in a hybrid reimbursement world for a long time to come.

Mike also told me about how Allscripts was well positioned to help with doctor’s CCM efforts because at the core of the CCM program is access to healthcare data, analytics capabilities, and call center capabilities to follow up with the patients. Sure, there are a few more details to the program, but Mike is right that CCM requires the right healthcare data, data processing, and the right patient follow up procedures. For many patients a phone call is still the best follow up procedure. Although, I’m still interested to see how quickly this switches over to secure text from phone calls.

What seems clear to me is that most provider organizations aren’t going to take part in CCM on their own. A few larger ones will try it, but most provider organizations will be looking to an outside company to help them participate in the CCM program together with a larger group of providers.

Of course, we also have to realize that CCM is just the start. The companies that deliver great CCM solutions will be well positioned to deliver on future value based care programs. They’ll just want to make sure that they balance their value based care work together with the ongoing fee for service world.

Prematurely Calling the End of Small Practices

Posted on October 16, 2015 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.

I continue to hear people predicting the death of small practices. In fact, I’ve met many vendor executives that have essentially started treating small practices as an extinct species. While there are certainly a lot of pressures and challenges associated with running a small practice today, we’re far from the end of small practices.

The biggest challenge to small practices is these major hospital systems that are buying up small practices left and right. We’ve seen this happen all over the country and they’ve become extremely dominant in some parts of the country. No doubt this is a threat to many of the small practices out there and is worth watching.

While many hospital systems are buying up practices, I over heard Dr. Halee Fischer-Wright, President and CEO of MGMA, make a really interesting counter point to this trend. The media and the acquiring hospital systems love to talk about small practices being acquired. However, we don’t give the same coverage to all of the doctors who leave a hospital system or those practices which get divested from a hospital system because they’re not working out as expected.

What does this mean? It means we hear about all of the small practices being acquired, but we don’t really hear about the small practices that leave the hospital system. This means we likely have a false impression of how many small practices actually still exist. I still know of many in my local area and I’m sure you do too. They just don’t get the same coverage as the large systems.

I do think that this current health care environment is harder for small practices than it was previously. The shift to value based care will continue that pressure. However, I heard over and over at MGMA about small practices coming together with vendors to be able to receive the benefits of value based reimbursement while still maintaining their independence.

Certainly this is no longer your father and your grandfather’s healthcare system. However, I still think the small practice is alive and will be for a long time to come.

90% of the World’s Data Was Created in the Last 12 Months

Posted on October 14, 2015 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.

Vala Afshar shared the following data insight from @salesforce.

Then, Jim Rawson, MD asked an important question for those of us in healthcare: How do you plan to manage it?

I’ve been having a discussion around healthcare data with a lot of people recently. One person I talked with at MGMA says we need more filters with that data. I thought it was interesting that he used the word filters. I’m not sure it’s quite the right word since filters means you only look at part of the data. In healthcare we need something that looks at all the data, but only boils up the data that matters to the healthcare provider at the time and place they need it.

Unfortunately, I’ve seen most healthcare analytics and healthcare data companies focused on the data. I haven’t seen many of them really work on the intelligence (filters if you prefer) that’s needed on top of that data. Healthcare organizations need solutions. They don’t need more tools.

We all know why companies are providing tools as opposed to solutions. It’s much easier to build the tools. It’s much harder to discover and share the solutions. However, the reward is going to be massive for those organizations that provide solutions.

Going back to the original question: How do you plan to manage all the data? I think that most healthcare providers have no idea. I think they assume they’ll be able to purchase solutions that do the work for them. I’m not seeing many of those solutions yet, but I’m sure they’re coming.

Chronic Care Management Infographic

Posted on October 13, 2015 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.

Smartlink Mobile Systems has put out an infographic that looks at interest in the chronic care management program by physicians. This data is quite interesting since the chronic care management program has been one of the popular topics at the MGMA annual conference this week. There’s a lot of discussion about the program and a lot of organizations trying to work out how to do the program effectively. I think that’s illustrated in the graphic below.
Chronic Care Management Infographic

What do you think of the Chronic Care Management program? Are you participating? Are you planning to participate? I’m sure we’ll be writing a lot more about this in the future.

Bold Insights from the #MGMA15 Keynote Kickoff

Posted on October 12, 2015 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.

Yesterday was the start of the MGMA Annual conference in Nashville. The event kicked off with a really great opening keynote from MGMA’s President and CEO Dr. Halee Fischer-Wright. While most keynotes from organization Presidents are boring and dry, I loved how candid and straight forward Dr. Fischer-Wright was in her comments. She definitely is pushing forward a new vision for the organization.

Here’s some highlights I tweeted from her keynote:


This reminds me of my post on EHR induced PTSD. I could have easily called that post Healthcare Buzzword induced PTSD.


Pretty brave of her to be so bold. I’ll be interested to hear people’s reactions.


I agree with her that Healthcare has changed, but I’d also argue that healthcare is still changing. That just compounds the problem.


I agree that apathy is an extraordinary challenge. Most doctors and healthcare professionals feel paralyzed and feel that they can’t do anything to make a difference or change the trajectory of where healthcare is headed. That’s a good thing since that’s a perception you can change. Apathy because people don’t care would be a much harder challenge.


This leads to some apathy as well, but also is converting to anger.

Needless to say I was impressed by Dr. Fischer-Wright. Appropriately, Jeremy Gutsche spoke after Dr. Fischer-Wright and commented about the need of organizations and people to take risks and fail. Much of the learning we get comes from taking risks and accepting that sometimes we’re going to fail. I think that’s where Dr. Fischer-Wright is taking the MGMA organization. She’s looking at big, ambitious goals. She might fail at some, but I predict that those that don’t fail are going to make a big difference.

#MGMA14 Twitter Roundup

Posted on October 27, 2014 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.

I’ve been spending the past couple days at the MGMA Annual conference in Las Vegas. It’s been interesting to talk to many of the leaders in healthcare. There seems to be a lot of confusion and uncertainty in the air. In fact, that seems to be the case at all the healthcare conferences I’m attending lately. While the industry is going through a turbulent period, it’s still been interesting to see the ongoing evolution that’s happening.

The Twitter stream has been a little disappointing to me. I’d like to see more attendees tweeting content. The vendors are extremely active. However, I found a few tweets which highlight a few of the topics being discussed.


I’m always amazed with how many people want their EHR to be connected. If it being connected was so valued by end users, then why hasn’t it happened? There’s still a misalignment of incentives that needs to be solved.


Lots of these ideas floating around. Everyone agrees that the move to some sort of quality based reimbursement is coming. We’re going to see a lot more discussions like the one above. Unfortunately, right now it’s a lot of speculation.


I wasn’t able to make this session, but it certainly brings up some interesting questions. We’ve written a number of times before about the value of a practice with and without an EHR. This certainly seems to call into question whether a practice without EHR is worth saving. This is going to become a really interesting topic as more doctors who’ve never used EHR in their practice decide to retire.

MGMA Raises Meaningful Use Stage 2 Concerns

Posted on August 26, 2013 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.

Becoming another of several groups asking for Meaningful Use changes, the head of the Medical Group Management Association has written a letter to HHS outlining several concerns the group has with Meaningful Use Stage 2.

In the letter, which was addressed to HHS Secretary Kathleen Sebelius, MGMA President and CEO Susan Turney raised several issues regarding the ability of her members to step up to Stage 2. She argued that physicians have a “diminished opportunity” to achieve Stage 2 compliance, and that as a result it would be unfair to impose Medicare reimbursement sanctions on her members. Turney argues that HHS should institute an “indefinite moratorium” on practices that have successfully nailed Stage 1 Meaningful Use requirements.

Why should HHS give practices a break?  The reason, she says, is that vendors are proving slow to produce Stage 2-certified products, leaving medical practices in the lurch. At the time of writing, Turney said, there were only 75 products and 21 complete EMRs certified for Stage 2 criteria, a small fraction of the more than 2,200 products and nearly 1,400 complete EMRs certified under 2011 criteria for ambulatory eligible professionals.

With vendors largely not ready yet to help practices through Stage 2, practices are likely to have little time to work on software upgrades or expect timely vendor support, she notes. And worse, EPs who invested big in Stage 1-certified EMRs might need to “rip and replace” them for a new one certified to meet Stage 2 if they want to avoid Medicare reimbursement cutback deadline.

On top of all of this, she notes, many practices are having to wait in line for Stage 2 upgrades of their EMR product behind practices adopting  an EMR for the first time. The wait is lengthened, meanwhile, by vendors’ attempts to cope with ICD-10 support, whose Oct. 1, 2014 deadline falls right in the middle of preparations for Meaningful Use Stage 2.

Turney makes a lot of sense in her comments. The vendor market clearly isn’t going to be able to keep up with ICD-10, MU upgrades and new installation within the same time period. I don’t know if an indefinite moratorium on Medicare penalties is the right policy response, but it should certainly be given some thought.

After all, punishing doctors who drop out of Meaningful Use due to factors beyond their control isn’t going to help anyone, either.

Are Large EHR Vendors More Likely to Shut Down an EHR Than Small EHR?

Posted on May 9, 2012 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.

As most people who have read this blog for a while, you know that I try to bring you raw perspectives on things that a lot of people don’t want to talk about. Plus, I don’t mind arguing the other side of topics in order to provide a more well rounded view of an important topic. One of my main goals is to provide the information necessary for doctors to make great decisions.

I recently got into a lengthy discussion with someone about EHR vendor selection. They suggested that doctors should look to the 5 EHR market leaders in their EHR selection process (I believe he sold one of those EHR market leaders). He made some very good points about the market leaders ability to support all stages of meaningful use, that they have a solid business model that will support doctors for the long term, and that they have the resources to support an EHR software for the long run. He also provided some reasonable cautions around small EHR vendors with skeptical business models that might not be around a few years from now.

Certainly the points he makes have merit and are worthy of consideration. Although, unlike this person, I’m not so ready to throw the rest of the non-top 5 EHR vendors out and I think it’s a mistake for a doctor or practice manager to do so as well.

As I considered on this discussion, I realized that over the past 5-7 years, it’s many of the big EHR vendors that have closed up their EHR software. Possibly even more than the various startup EHR companies. Here are just a few examples of large companies shuttering their EHR: Misys (billion dollar company if I remember right), Epocrates and GE Centricity Advance (one of GE’s suite of EHR). Of course, Misys merged with Allscripts (if you call it a merger since they were going bankrupt), but I know a lot of unhappy Misys users that don’t know what to do now. GE has many other Centricity products as well and seems to have made a smoother transition for their Centricity Advance users. At least that’s within the same company. Epocrates is a large company, but didn’t have many EHR users.

My point of course is that even EHR software from large EHR vendors aren’t safe from possible future issues. In fact, I could make a reasonable case for why a smaller EHR vendor that’s grown in a sustainable way over a long period of time is in a better financial position than a HUGE company with a lot of overhead. Plus, I know personally A LOT of these small EHR vendor CEOs. They love what they’re doing and they’re in this for the long haul.

Now with 600+ EHR vendors out there, I’m certainly not saying that all of them have great business models. I was blown away when I met one at MGMA who had 1 doctor using their system. I hope whoever they sign up second is aware of the situation and is going in with both eyes open. There are certainly risks associated with being the second doctor on an EHR software, but there are also plenty of benefits as well. When you suggest something be changed, there’s a good chance you’ll get that change.

Conclusion
There are good small EHR companies.
There are good large EHR companies.
There are bad small EHR companies.
There are bad large EHR companies.

I guess what I’m saying is that size doesn’t matter in EHR selection. There are much more important factors to consider.

An Interesting MGMA Observation

Posted on October 25, 2011 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.

Lately I’ve been traveling to more and more EMR and Healthcare IT related conferences. The past couple days I’ve been enjoying my time at the MGMA conference in Las Vegas (although, I didn’t have to travel to this one since I live in Las Vegas). This is my first time attending the MGMA conference. From what I can tell the attendance and exhibit hall have done very well. In fact, I just asked and they’ve had 3500 conference attendees and a total of 5700 people in Las Vegas for the MGMA conference. They tell me that’s a 19% growth over last year.

What I’ve found most interesting is that unlike many conferences I’ve been at, the sessions at MGMA have been incredibly full. In fact, many of them have been standing room only. This is in contrast to the exhibit floor which has felt rather empty. There are a few short periods that were busy in the exhibit hall, but overall it seems like MGMA attendees prefer to go to the educational session as opposed to being in the exhibit hall.

I asked professional conference attender (otherwise known as Healthcare IT journalist) Neil Versel who blogs at Meaningful Health IT News why this might be the case. He said that maybe those attending MGMA have already made their EHR selection, so they’re more interested in hearing from experts as opposed to browsing products. Of course, he did highlight that it was those that attended had already implemented an EHR since we know that the majority have not yet implemented an EHR.

While I think this could be part of the reason, I wonder if there’s not something more at work. If I’d done better at taking notes during the Marcus Buckingham keynote, I could maybe look at the profiles he found in the MGMA audience to explain it. A part of me wonders how many of the MGMA attendees are decision makers as opposed to operational leaders. I’m sure they’re all over the spectrum, but sessions are likely more interesting for operations and compliance people.

As a first time attendee, I’ve been really impressed with MGMA. They’re well organized and brought together a lot of interesting vendors and attendees.