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MIPS Twitter Roundup – MACRA Monday

Posted on December 11, 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 (QPP) and related topics.

As we near the end of 2017, I found a number of tweets from CMS and other people that I thought would be useful to those that are interested in MACRA and MIPS.

First up is this tweet from CMS that it’s not too late to still participate in MIPS and collect some performance data before the end of 2017. This is them promoting the Test Option which would allow you to avoid the 4% penalty:

Next up is a fact sheet from CMS which outlines the different between 2017 and 2018 when it comes to MACRA/MIPS. I particularly like page 6 of the document. As you go through it, you’ll realize why 2018 is going to be much harder than 2017.

Next up is a stat from MGMA. I’d be interested in learning about the 14% of practices that think that their value-based reimbursement is going to decrease. Are these people going to direct primary care? I don’t see it going down for almost anyone. What do you think?

Finally, Matt Fisher asks a question about whether MIPS should be voluntary. I don’t think they can make it any more voluntary given the current legislation and do any of us think that congress is going to take up this topic? I don’t. So, it’s kind of a moot point. However, there is a lot of doctor angst about MIPS/MACRA. I just don’t see enough of it to really move the needle on things. I think we’re stuck with MACRA/MIPS for the forseeable future.

Burnout is Overused and Under Defined

Posted on December 8, 2017 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.

Recently, John hosted a #HITsm chat on using technology to fight physician burnout (Read the full transcript from the chat here). The topic’s certainly timely, and it got me to wondering just what is physician burnout. Now, the simple answer is fatigue. However, when I started to look around for studies and insights, I realized that burnout is neither easily defined nor understood.

The Mayo Clinic, among others, defines it this way:

Job burnout is a special type of job stress — a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work. 

So, it is fatigue plus self doubt. Well, that’s for starters. Burnout has its own literature niche and psychologists have taken several different cracks at a more definitive definition without any consensus other than it’s a form of depression, which doesn’t have to be work related.

Unsurprisingly, burnout is not in the DSM-5. It’s this lack of a clinical definition, which makes it easy to use burnout like catsup to cover a host of issues. I think this is exactly why we have so many references to physician or EHR burnout. You can use burnout to cover whatever you want.

It’s easy to find articles citing EHRs and burnout. For example, a year ago April, The Hospitalist headlined, “Research Shows Link Between EHR and Physician Burnout.” The article then flatly says, “The EHR has been identified as a major contributor to physician burnout.” However, it never cites a study to back this up.

If you track back through its references, you’ll wind up at a 2013 AMA study, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.” Developed by the Rand Corporation, it’s an extensive study of physician job satisfaction. Unfortunately, for those who cite it for EHR and burnout, it never links the two. In fact, the article never discusses the two together.

Not surprisingly, burnout has found its way into marketing. For example, DataMatrix says:

Physician burnout can be described as a public health crisis especially with the substantial increase over the last couple of years. The consequences are significant and affect the healthcare system by affecting the quality of care, health care costs and patient safety.

Their solution, of course, is to buy their transcription services.

What’s happened here is that physician work life dissatisfaction has been smushed together with burnout, which does a disservice to both. For example, Medscape recently published a study on burnout, which asked physicians about their experience. Interestingly, the choices it gave, such as low income, too many difficult patients – difficult being undefined — are all over the place.

That’s not to say that all physician burnout studies are useless. A recent study, Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative, used a simple, five item scale to ask physicians how they viewed their work life. See Figure 1.

Figure 1 Single-Item Burnout Scale.

Their findings were far more nuanced than many others. EHRs played a role, but so did long hours. They found:

EHR proficiency training has been associated with improved job satisfaction and work-life balance.14 While increasing EHR proficiency may help, there are many potential reasons for physicians to spend after-hours on the EHR, including time management issues, inadequate clinic staffing, patient complexity, lack of scribes, challenges in mastering automatic dictation systems, cosigning resident notes, messaging, and preparing records for the next day. All of these issues and their impact on burnout and work-life balance are potential areas for future research.

There’s a need to back off the burnout rhetoric. Burnout’s overused and under defined. It’s a label for what may be any number of underlying issues. Subsuming these into one general, glitzy term, which lacks clinical definition trivializes serious problems. The next time you see something defined as physician or EHR burnout, you might just ask yourself, what is that again?

Patient Data Sharing and EMR Usability

Posted on December 7, 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 been a while since we’ve done a Twitter roundup, so it was time to do one again. This time we highlight 3 recent tweets that will make you go hmmmmm. Lots of great insights from amazing people.


More and more people are open to sharing their records. However, there’s still a lot of education needed for people that are afraid that sharing their records could harm them. While there is that risk, it’s important to remember that not sharing your records could harm you too.


Is this the right balance or resonsibility? Should vendors, leaders, and clinicians all be responsible? Is the reason EMRs aren’t usable is that it takes all 3 of these groups working together to make it usable?


I’ll just leave this one here without comment. Lots to chew on in this image!

Telehealth and Its Contribution to Healthcare

Posted on December 6, 2017 I Written By

The following is a guest blog post by Juan Pablo Segura, Co-founder & President of Babyscripts.

In 2016, Americans spent roughly 18% of GDP on healthcare. Abetted by an aging population and continuously rising costs of care, CMS projects that this number will only grow over the next decade, increasing at an average of 5.6% annually. A crisis seems unavoidable: yet a huge fraction of this sum is lost to inefficient spending, which, when compared to other factors like an aging population, socio-economic challenges, or expensive new treatments, seems completely within the industry’s control to control and eliminate. A new OECD report calculates that approximately 20 cents out of every dollar spent on healthcare are considered unnecessary.

Could a simple reallocation of time and resources be enough to check the seemingly inevitable? The potential cost-savings of such a reallocation has policymakers and health professionals poised to revolutionize healthcare, as an industry that has long been resistant to innovation rejects antiquated models of care for more efficient methods that prioritize patient and provider alike.

A simple resolution that is already allowing more patients to receive necessary and important primary care is the extension of care teams through mid-level providers that cost a fraction of the salary of a full time physician. Physician’s Assistants and nurse practitioners are being granted more autonomy, as State governments remove restrictions while enacting legislation that grants PAs and other personnel full prescriptive authority. Allowing these lower cost health professionals to perform routine, primary care instead of more expensive, specialized physicians, immediately eliminates inefficiencies in the system and increases access to care to patients in the midst of a physician shortage.

These changes in personnel are necessary, but not enough to respond to the changing face of care. The answer to more affordable care is in leveraging existing technologies.

The rapid adoption of synchronous, video visits between patients and providers across the country is an exciting example of how technology can eliminate waste and help the system reallocate its resources. Recognizing its potential to decrease the administrative demands on providers and facilitate access to patients in remote areas, the industry has placed great emphasis on this aspect of telemedicine, even to the extent of providing incentives to providers for facilitating care through video.

But far from being the solution, video visits just scratch the surface of technology’s potential contributions to affordable healthcare, and in fact are the least beneficial of the efficiencies that technology is poised to provide. Some studies have indicated that when video visits are included in a medical plan, patients tend to treat them as an add-on, rather than a replacement for traditional in-person care. Furthermore, without integrated systems, video visits function much as if a patient were receiving all medical care at the ER, producing a fractured and incomplete medical record.

The dialogue must be centered on those innovations that revolutionize the way we approach healthcare, not simply attempt to translate an outdated system into a world that has evolved past it.

The conversation needs to focus on the most relevant, effective and impactful technology tools to affect the ultimate cost of care. Already, forward thinking providers like Greenville Health are creating end to end “virtual strategies” that rely heavily on remote monitoring apps and asynchronous visits that have the capacity to identify the problems before they begin. Beyond the immediate benefit of proper allocation of time and resources, the ultimate goal of technological innovation in healthcare has always been the opportunity to identify potential problems and create the necessary infrastructure to allow our healthcare system to focus on preventative health.

Of the healthcare apps currently in the digital marketplace, some have been shown not only to decrease costs but to be as successful as medication in preventing complications, anticipating a future of decreased prescription costs. Remote monitoring programs that use IOT devices like blood pressure cuffs and weight scales have reduced the cost of prenatal care by 40% while detecting problems like preeclampsia and other high-risk illnesses. Yet there is very little coding or direct payer incentive for deploying preventative technologies like that provided for video visits.

And why not? Video visits are a move in the right direction, but the decrease to cost of care does not have to come at the expense of the client/physician relationship or integrated care. Instead, effective technology should cut costs while assuring patient and provider of the continuity and efficacy of care.

The conversation amongst policymakers needs to expand to include these more revolutionary aspects of digital health, rewarding those who are effectively reducing costs without compromising care. Digital health will not be confined to a narrow vision, but it is up to the government and the industry to expedite the future of healthcare.

About Juan Pablo Segura
Juan Pablo Segura is Co-founder & President of Babyscripts, a Washington, DC-based technology company that builds mobile and digital tools to empower women to have better pregnancies. Juan Pablo was named a Wireless Life Saver by CTIA and a health care Transformer by the Startup Health Academy in New York City.

EHR-Based Order Prioritization Could Streamline MRI Use

Posted on December 5, 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.

New research suggests that the overuse of STAT requests for MRIs could be trimmed down considerably if criteria for using such requests were integrated into healthcare organizations’ EHRs. The study also suggests, indirectly at least, that adding timing requests for various procedures into EHRs could help with overall workflow in many facilities.

Researchers from Emory University School of Medicine in Atlanta, who presented their findings at the RSNA 2017 show last month, found that the volume of STAT brain MRIs had increased to the point where 60% of all MRI orders were ordered as STAT between 2012 and 2015.

The increasing use of the STAT designation has ended up creating a bottleneck, researchers concluded. They found that the volume of STAT requests for brain MRIs was so high that it actually led to delays in turnarounds for those studies. In fact, they found that the mean turnaround time for STAT brain MRIs was roughly 50% longer than routine brain MRIs (23.43 hours versus 15.46 hours).

Among the sources of this problem, it seems, is that few clinicians were aware of the hospital’s policy for STAT MRIs. In an online survey of 97 providers, only 4% were aware that a STAT imaging study should be initiated within 30 minutes of the order. Instead, many expected that a stat MRI would be completed within the same day for inpatients within 2 to 3 days for outpatients, according to a story appearing in Radiology Business.

To address this problem, the researchers are proposing that hospitals add order prioritization criteria to their EHR.  These criteria will include definitions and clinical examples to help clinicians sort out which category to use when ordering a brain MRI.

This approach would also help clinicians better understand how the institution defines normal versus STAT priority for imaging orders. The researchers are recommending that hospitals include EMR documentation defining both STAT and routine categories, as well as a statement of when they can expect imaging to be completed under each category.

Adding categories and definitions of when imaging orders should be categorized as STAT would actually appeal to clinicians, the study suggests. Researchers found that more than 70% of clinicians said they would find clinical examples of an order prioritization scheme useful. What’s more, 84% of clinicians responding to the study said they would order routine MRIs if they were assured the studies would be completed within 24 hours.

The authors admitted that integrating order prioritization schemes for imaging could be time-consuming for IT departments, which suggests that finding other ways to set these priorities over the short term is probably a good idea. But given how supportive clinicians seem to be the idea of improving order turnaround, it seems likely that the EHR integration work should get done before too long.

Are Improved EMR UI Designs On The Way? I Doubt It

Posted on December 4, 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.

More or less since EMRs were first deployed, providers have been complaining about the poor quality of the interface they’ve had to use.  Quite reasonably, clinicians complained that these interfaces weren’t intuitive, required countless extra keystrokes and forced their work processes into new and uncomfortable patterns.

Despite many years of back and forth, EMR vendors don’t seem to be doing much better. But if a new story appearing in Modern Healthcare is to be believed, vendors are at least trying harder. (Better late than never, I suppose.)

For example, the story notes, designers at Allscripts create a storyboard to test new user interface designs on providers before they actually develop the coded UI. They use the storyboard to figure out where features should sit on a given screen.

According to the magazine, designers at several other EMR vendors have begun going through similar processes. “They are consulting with and observing users inside and outside of their natural work environments to build EHRs for efficient – and pleasant – workflows, layouts and functionality,” the magazine reports.

Reporter Rachel Arndt says that major EHR vendors now rely on a mix of approaches such as formal user testing and collection of informal feedback from end-users to meet their products more usable for clinicians. In some cases, this has evolved into official UI design partnerships between EHR vendors and customers, the story says.

Okay. I get it. We’re supposed to believe that vendors have finally gotten their heads together and are working to make end-users of their products happier and more productive. But given the negative feedback I still get from clinicians, I find myself feeling rather skeptical that the EHR vendors have suddenly gotten religion where UI design is concerned.

For what it’s worth, I have no doubt that Ms. Arndt reported accurately what the vendors were telling her. If any of us would ask vendors they are partnering with customers – especially end-users – to make their products more intuitive to work with, they will swear on a stack of user manuals that they’re improving usability every day.

Until I hear otherwise, though, I’m not going to assume that conditions have changed much out there where EHR usability is concerned. Today, all the feedback I get suggests that EHRs are still being designed to meet the needs of senior management within provider organizations, not the doctors and nurses that have to use them every day.

Of course, I hope I’m wrong, and that the story is accurate in ways that offer some hope to clinicians. But for now, color me very doubtful that EMR vendors are making any earth-shattering UI improvements at present.

Will 2018 Be The Year Of The Health IT/Non-Health-IT Merger?

Posted on December 1, 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.

Within the last several days, the news broke that Amazon Web Services would probably be doing some sort of far-reaching cloud deal with Cerner. Given that AWS is a nearly $20 billion cloud organization, and Cerner one of the largest health IT players in the game, a lot could happen here.

My guess, not that it’s any leap of imaginative genius, is that if the currently-rumored deal between the two partners works, Amazon will make a serious bid to buy out Cerner as a whole. Given the massive profits potentially at stake in health IT, the idea of such an acquisition seems credible to me, at least if Cerner’s stockholders approve. After all, isn’t Amazon the company that just did a multibillion-dollar buyout of Whole Foods to fuel its growing (but still relatively small-scale) efforts in food retailing?

Not only is this particular deal interesting, I think it may portend some major structural changes in the health IT business as a whole. Specifically, I think we’re reaching a point where there will be a lot of pressure on companies with adequate cash and compatible goals to target HIT organizations, particularly if they need to scale up quickly and don’t have much internal knowledge on the subject.

And there’s no question that as healthcare settles into being a digital business, a range of digital businesses outside of healthcare will see that as an opportunity to step into such an important market. After all, how could they not want to be part of any organization that’s competing effectively in an industry that consumes a double-digit portion of the US GDP?

Over this period, many small internal workgroups outside healthcare will be transformed into scouting units seeking the next big digital healthcare deal. At the same time, these divisions will start forming quiet alliances strategic to their business, not only with giants like Cerner and Epic but also well-positioned startups in hot areas such as, say, blockchain security or supply chain management. (How could an ERP vendor not wonder how a healthcare supply chain management company running over blockchain could enhance their business?)

Then, of course, there are the more obvious moves which will bring a new critical mass of health IT customers, knowledge and talent to companies with a giant market presence already, such as Apple and Samsung.

Such M&A efforts won’t be optional. As Microsoft’s experience has proven in the past, and Amazon has apparently found more recently, you can’t just storm into the enterprise healthcare world and demand your cut, no matter how big a player you are. Getting there will take a well-finessed, mutually-fruitful agreement, if not an acquisition, even for a mega-company like Google/Alphabet.

Now, can I tell you which companies will be executing on such deals next year? I have a few theories, but no specific intelligence to share that you couldn’t pick up on your own by skimming industry headlines. But I do stand by my prediction that by the end of 2018, we’ll have seen a few spectacular deals between HIT vendors and digital companies outside the industry that will have a major influence for years to come.