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DrChrono App Store Illustrates Important Point

Posted on July 16, 2018 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.

In a recent post, my colleague John Lynn argued that EHRs won’t survive if they stick to a centralized model.  He contends — I think correctly — that ambulatory practices will need to plug best-of-class apps into their EHR system rather than accepting whatever their vendor has available. If they don’t create a flexible infrastructure, they’ll be forced to switch systems when they hit the wall with their current EHR, he writes.

Demonstrating that John, as usual, has read the writing on the wall correctly, I present you with the following. I think it illustrates John’s point exactly. I’m pointing to EHR vendor DrChrono, which just announced that billing and collections company Collectly would be available for use.

Like its peers, Collectly built on the DrChrono API, and will be available in the DrChrono App Directory on a subscription basis. (The billing company also offers custom pricing for large organizations.)

Other apps featured in the app directory include Calibrater Health, which offers text-based patient surveys; Staple Health, a machine learning platform that providers can use to manage at-risk patients and Genius Video, which sends personalized video via text message to educate patients. Payment services vendor Square is also a featured partner.

Collectly, for its part, digitizes paper bills and sends billing statements and collection notices to patients via text or email. The patient messages include a link to the patient portal which offers a billing FAQ, benefits and insurance info and a live chat feature where experts offer info on patient insurance features and payment policy. The live chat staffers can also help patients create an approved payment schedule on behalf of a practice.

While some of the DrChrono apps offer help with well-understood back-office issues – such as Health eFilings, which help practices submit accurate MIPS data –  those functions may be duplicated or at least partially available elsewhere. However, apps like Collectly offer options that EHRs and practice management platforms seldom do. The number of best of breed apps that an EHR won’t be able to replicate natively is going to continue to increase.

Integrating consumer-facing apps like this acknowledges that neither medical practice technology nor its staff is terribly well-equipped to bring in the cash from patients. It may take outside apps like Collectly, which functions like an RCM tool but talks like a patient, to bring in more patient payments in for DrChrono’s customers. In other words, it took a decentralized model to get this done. John called it.

QPP (Quality Payment Program) 2019 Changes, Medicare Telemedicine Reimbursement, and Physician Fee Schedule E&M Changes

Posted on July 12, 2018 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.

Today, CMS came out with some big changes as part of the 2019 Physician Fee Schedule and proposed rule for the QPP for 2019. These are some of the biggest efforts I’ve seen to try and change what Medicare has been doing for a while.

CMS has put together a fact sheet on the 2019 Physician Fee Schedule proposed rule. Plus, you can also view the fact sheet for the 2019 Quality Payment Program (QPP) proposed rule. If you like all the details, you can find the full rule for both the 2019 Physician Fee Schedule and QPP 2019 (1473 pages) on the Federal Register.

That’s a lot of information and changes to process, but here are some initial thoughts. While what CMS and HHS are saying in their announcement is directionally good, the devil is always in the details. Here are a few of the highlights that could have a big impact on the healthcare IT and EHR world.

E/M Documentation Requirement Changes
The biggest change in this announcement is the change in E/M coding requirements. As part of CMS’ goal to streamline E/M documentation requirements, they’ve proposed some of the biggest changes to E/M since 1997. The one that will likely be talked about most is the opportunity for providers to bill Medicare using “medical decision-making or time.” Here’s a description of the change:

To improve payment accuracy and simplify documentation, we propose new, single blended payment rates for new and established patients for office/outpatient E/M level 2 through 5 visits and a series of add-on codes to reflect resources involved in furnishing primary care and non-procedural specialty generally recognized services. As a corollary to this proposal, we propose to apply a minimum documentation standard where Medicare would require information to support a level 2 CPT visit code for history, exam and/or medical decision-making in cases where practitioners choose to use the current framework, or, as proposed, medical decision-making to document E/M level 2 through 5 visits. In cases where practitioners choose to use time to document E/M visits, we propose to require practitioners to document the medical necessity of the visit and show the total amount of time spent by the billing practitioner face-to-face with the patient. Practitioners could choose to document additional information for clinical, legal, operational or other purposes, and we anticipate that for those reasons, they would continue generally to document medical record information consistent with the level of care furnished. However, we would only require documentation to support the medical necessity of the visit and associated with the current level 2 CPT visit code.

There are other changes to E/M that could be a big deal as well including having providers focus their documentation on what’s changed since the last visit as long as they review and update the previous information. Plus, providers can now just review and verify the information entered by ancillary staff or the patient rather than having to re-enter it.

The goal is quite clear. CMS is trying to battle against the bloated notes that are getting generated by EHRs today to justify a certain billing code level. Doctors will no doubt celebrate this as most doctors describe notes from their peers as awful and difficult to use because of all the note bloat. I don’t know how many times I heard from my medical billing friends at AHIMA that it doesn’t matter what’s actually done if it’s not documented. With the changes mentioned above, CMS is looking to change this.

Of course, EHRs aren’t going to be able to change their interfaces overnight. The new E/M changes are going to take a while to incorporate into EHR software. Plus, we’ll have to see how the non-Medicare payers react to these changes. If they don’t follow Medicare’s lead, that puts the EHR vendors in a tough position. We’ll have to see how that plays out.

Many doctors complain about hating their EHR software. I’ve long argued that the EHR is just the whipping boy for doctors’ ire. What doctors really hated was the crazy billing documentation requirements that were reflected in the EHR. If the changes above go far enough, maybe we’ll finally see if the EHR vendor really is to blame for provider burnout. However, as I mentioned, it will take some time for this to happen.

Medicare Telemedicine and Telehealth Reimbursement
The next biggest thing in today’s announcement was Medicare’s plans to reimbursement for what we would call Telemedicine or Telehealth services. 2 G codes (HCPCS code GVCI1 and GRAS1) were announced that seem like they could present a lot of opportunity for healthcare IT companies to finally get paid for the services they can provide:

Brief Communication Technology-based Service, e.g. Virtual Check-in (HCPCS code GVCI1)

Remote Evaluation of Recorded Video and/or Images Submitted by the Patient (HCPCS code GRAS1)

Practitioners could be separately paid for the Brief Communication Technology-based Service when they check in with beneficiaries via telephone or other telecommunications device to decide whether an office visit or other service is needed. This would increase efficiency for practitioners and convenience for beneficiaries. Similarly, the Remote Evaluation of Recorded Video and/or Images Submitted by the Patient would allow practitioners to be separately paid for reviewing patient-transmitted photo or video information conducted via pre-recorded “store and forward” video or image technology to assess whether a visit is needed.

Travie Broome offered some interesting insights into these codes:

CMS also proposed a number of CPT codes for “Chronic Care Remote Physiologic Monitoring” and “Interprofessional Internet Consultation” as follows:

We are also proposing to pay separately for new coding describing Chronic Care Remote Physiologic Monitoring (CPT codes 990X0, 990X1, and 994X9) and Interprofessional Internet Consultation (CPT codes 994X6, 994X0, 99446, 99447, 99448, and 99449).

The also proposed adding HCPCS codes G0513 and G0514 for Prolonged preventive service(s) which seems to include ESRD (end-stage renal disease) patients who receive dialysis at home and mobile stroke units.

QPP (Quality Payment Program, better known as MACRA and MIPS) Changes
I have to admit that the changes to the QPP program didn’t feel nearly as substantial. The QPP 2019 Fact Sheet seemed short on details and I haven’t had a chance to fully digest the full rule. A few highlights though:

  • 2019 QPP will remove the MIPS process-based quality measures
  • MIPS Expands to PTs, OTs, CSWs and clinical psychologists (which was required by law)
  • It will overhaul the “Promoting Interoperability” category (pretty generic and haven’t figured out what this really means, but they say it will focus on interoperability, imagine that!)
  • The Promoting Interoperability scoring has changed and so has some of the weighting, but nothing major
  • Many of those excluded from MIPS in 2018 can opt in to participate if they want in 2019
  • $500 million pool is available for exceptional performance (whith is now at 80 points vs 70 in 2017)
  • Must use a 2015 Certified EHR (officially a 2015 Edition CEHRT)

Those are some of the big changes I saw offhand.  I’d suggest that this is mostly business as usual for the most part.  Significant if you’re in the MACRA and MIPS weeds, but isn’t likely going to change your MACRA and MIPS strategy.

One change I’m still processing is this one:

Changing the application of MIPS payment adjustments, so that the adjustments will not apply to all items and services under Medicare Part B, but will now apply only to covered professional services paid under or based on the Physician Fee Schedule beginning with 2019, which is the first payment year of the program.

Does this change the analysis that Jim Tate did previously that MIPS Penalties (and incentives for that matter) included Medicare Part B drugs? Sounds like it to me. If I’m reading it right, this change means that the penalties will be less for those getting penalized, but the payments will be less for those participating in the program as well. Not a good thing for a program that already has incentive problems. Is that right or am I reading it wrong?

On that note, this explains why the final rule is 1473 pages long. Time to do some reading of the final rule and see what all the experts find as they analyze it. Let us know what we missed in the comments or any analysis of this that we got wrong. We can all learn what this means together.

Plus, remember that this is just the proposed rule and CMS even asked for comment on if it should go into effect in 2019 or 2020. I encourage you all to provide your feedback on the proposed rule so it can be improved when it goes final.

How Are Ambulatory Practices Going to Compete with Health Systems?

Posted on July 9, 2018 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.

We’ve all seen the stories about the explosion of data and the way healthcare is getting more personalized. However, David Chou recently pointed out how the data is one thing, but figuring out the role everyone plays in your healthcare organization is just as important as the data itself. It gets complex quickly as this graphic David shared shows:

This is a great graphic of the healthcare analytics roles and responsibilities that will be needed to make the personalized medicine future a reality. Plus, it will be key to getting a lot of the value out of our past EHR investments. Many hospitals and health systems already have these roles filled or are working to have them filled. We’ve seen this first hand when we see data jobs being posted to our healthcare IT job board.

While this work is extremely exciting and shows a lot of promise, I imagine a graphic like the one above is just completely overwhelming to consider for a small ambulatory practice. Even a large group practice would likely find the above graphic challenging to consider in their relatively small healthcare organization. How can they compete with a large health system with that kind of complexity? Do graphics like the one above just provide one other illustration of why small practices are going to soon be extinct?

I don’t think so and I hope not. However, graphics like the one above do illustrate the tremendous challenges that ambulatory practices face when they don’t have a massive health system behind them. What’s the path forward for smaller practices then?

The first thing to remember is that even though a health system is large, it doesn’t mean it’s going to do things well. In fact, it’s easy to argue how large organizations are much less efficient. It’s not hard to see how a large health system will focus all of their analytics work on the acute care environment and leaves out ambulatory practices. Smaller healthcare organizations are going to have to use this to their advantage.

While it’s unlikely that ambulatory practices will do all of the healthcare analytics work on their own, it is possible for ambulatory practices to tap into third party vendors that do the work for them and hundreds of other ambulatory practices. Smaller healthcare organizations partnering with corporate and entrepreneurial vendors is going to be the best way for these healthcare organizations to compete with the large health system. In fact, it’s a huge opportunity for them to show why patients should visit their practice instead of the large health system.

One thing that’s holding these efforts back is EHR vendors’ decision to close the doors to outside vendors. There are a few EHR vendor exceptions and areas where every EHR vendor is more open (ie. labs, pharmacy, etc), but it won’t be enough going forward. My friend Jeremy Coleman recently described why in this series of tweets:

I don’t see any healthcare future where centralization will survive. Sure, it will put up a good fight for a while, but the number and variety of applications that are coming out in healthcare are going to be so varied and dramatically important for doctors to incorporate into the care they provide that EHR vendors won’t have a choice but to create APIs that facilitate all of these applications.

An EHR vendor that embraces this approach is going to be essential for every ambulatory practice. Eventually, ambulatory practices will be stuck with the need to switch EHR systems or sell to the health system (which generally means switching EHR systems too). However, an ambulatory EHR that provides an open ecosystem for the latest and greatest in health IT will allow ambulatory practices to thrive even against the much larger health systems.

AMA Hopes To Drive Healthcare AI

Posted on July 6, 2018 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.

Last month, the AMA adopted a new policy setting standards for its approach to the use of AI. Now, the question is how much leverage it will actually have on the use in the practice of medicine.

In its policy statement, the trade group said it would work to set standards on how AI can improve patient outcomes and physicians’ professional satisfaction. It also hopes to see that physicians get a say-so in the development, design, validation implementation of healthcare AI tools.

More specifically, the AMA said it would promote the development of well-designed, clinically-validated standards for healthcare AI, including that they:

  • Are designed and evaluated using best-practices user-centered design
  • Address bias and avoid introducing or exacerbating healthcare disparities when testing or deploying new AI tools
  • Safeguard patients’ and other individuals’ privacy and preserve security and integrity of personal information

That being said, I find myself wondering whether the AMA will have the chance to play a significant role in the evolution of AI tools. It certainly has a fair amount of competition.

It’s certainly worth noting that the organization is knee-deep in the development of digital health solutions. Its ventures include the MATTER incubator, which brings physicians and entrepreneurs together to solve healthcare problems; biotech incubator Sling Health, which is run by medical students; Health2047, which brings helps healthcare organizations and entrepreneurs work together and Xcertia, an AMA-backed non-profit which has developed a mobile health app framework.

On the other hand, the group certainly has a lot of competition for doctors’ attention. Over the last year or two, the use of AI in healthcare has gone from a nifty idea to a practical one, and many health systems are deploying platforms that integrate AI features. These platforms include tools helping doctors collaborate with care teams, avoid errors and identify oncoming crises within the patient population.

If you’re wondering why I’m bringing all this up, here’s why. Ordinarily, I wouldn’t bother to discuss an AMA policy statement — some of them are less interesting than watching grass grow — but in this case, it’s worth thinking about for a bit.

When you look at the big picture, it matters who drive the train when it comes to healthcare AI. If physicians take the lead, as the AMA would obviously prefer, we may be able to avoid the deployment of user-hostile platforms like many of the first-generation EHRs.

If hospitals end up dictating how physicians use AI technology, it might mean that we see another round of kludgy interfaces, lousy decision-support options and time-consuming documentation extras which will give physicians an unwanted feeling of deja-vu. Not to mention doctors who refuse to use it and try to upend efforts to use AI in healthcare.

Of course, some hospitals will have learned from their mistakes, but I’m guessing that many may not, and things could go downhill from there. Regardless, let’s hope that AI tools don’t become the next albatross hung around doctors’ necks.

Happy 4th of July

Posted on July 4, 2018 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.

Happy 4th of July to all of you! I’m grateful this day for the opportunity to be a blogger and be able to share all of the things we do with you. I know that freedom of the press isn’t available everywhere in the world. I hope everyone is enjoying this day with family and friends and taking time to enjoy the little things in life.

Happy 4th of July!

2017 MIPS Final Score and Performance Feedback Is Out

Posted on June 29, 2018 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.

Big news just came out for those that are participating in MACRA and MIPS. CMS Announced it on Twitter:

That’s right, you can now visit the QPP website and login to see and verify your 2017 MIPS final score and performance feedback. Interesting that they would choose to push this out late on a Friday. You’ll want to verify this information to make sure you’re paid correctly and to make sure they have the right data for you before they make all the MIPS scores public.

I looked at the Physician Compare website and unless I just didn’t look in the right places, I don’t see the MIPS Quality scores available on the website yet, but I expect they will be soon. Plus, they’re likely going to make the data available for download as a dataset. Once they do, websites like ZocDoc, Vitals, HealthGrades and the rest of the physician ratings and review websites will pull the data and incorporate it into their physician profiles. So, you’ll want to make sure your data is accurate.

I will say that when I was looking at physicians on the Physician Compare website, I was fascinated by the note they put as a popup for someone who had “Used electronic health record”:

To be fair, they did use the word “may”, but I think most doctors would say this is a far cry from what EHR software has accomplished. However, it’s clear what the intent of the legislation and CMS was when it came to adoption of EHR software.

Have you had a chance to look at your MIPS score and performance feedback? We’d love to hear about your experiences. We’ll be interested to see how these MIPS quality scores are used by doctors and patients.

Tips On Storing Patient Information In The Cloud

Posted on June 27, 2018 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.

These days, it’s pretty much a given that providers will store some or all of their data in the cloud, i.e. off-site on a vendor’s servers.  For many providers, doing this is a good idea, as it allows them to avoid buying dedicated hardware or upgrade their own storage capacity.

That being said, all cloud vendors are not made equal, and it’s important to pick the right one. After all, providers can face dire consequences if their patient data is breached. Even if the vendor is at fault, providers will take most or all of the blame.

Before storing data on an outside service, it’s important to check them out carefully.  Here are some tips on evaluating vendors from David McHale of The Doctors Company:

  • Research the vendor’s security practices: Find out of they have a good reputation and strong security policies in place. Whatever time you put into the research is time well spent.
  • Make sure the vendor can handle all of your data: Bear in mind that many cloud services company charge by the amount of storage providers use, so being sure those costs are affordable is important. Also, providers should make sure the vendor can handle the amount of data they’d like to store.
  • Be sure that your data is encrypted at all times: Providers should see to it that their data is encrypted when being uploaded to or downloaded from the cloud. This includes ensuring that browsers or apps require an encrypted connection to the vendor’s server.
  • Patient data should be encrypted when stored in the cloud: Never store data protected by law in the cloud, such as medical information or personal identifiers, unless the stored data is encrypted. Also, don’t let anyone decrypt the data unless they are authorized to do so.
  • Learn how access is stored in your cloud folder: Cloud storage vendors often let providers share access to online folders stored on their servers. and it’s important to know how that sharing works. For example, find out whether data in the folder is read-only or whether users can edit the file, and whether managers can find out who last edited a file.
  • Prepare for the worst: Providers should know what they’ll do if their cloud vendor gets hacked or their data is lost. To find this out, they should read the “terms of service” provisions of their contract, which often states that users have little recourse if their data is breached or lost.

To be sure, cloud storage can be a great way for providers to save money on storage and see that their data is backed up offsite. However, it’s important they do their due diligence and see that the vendor will protect that data carefully.

Medical Practice Use Of Automated Claims Options Growing Slowly

Posted on June 25, 2018 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.

A new study by a healthcare industry group has concluded that medical and dental practices are processing claims manually rather than going for full automation, a trend which is robbing the industry of very high levels of potential savings. While many physicians and dentists are using web portals to process claims, in most cases they haven’t reached the ”set it and forget it” level, a trend which could undercut possible savings.

The group, CAQH, tracks health plan and healthcare provider adoption of electronically-based administrative transactions for medical and dental practices. CAQH’s research estimates the time required for providers administrative transactions, including verifying a patient’s insurance coverage, sending and receiving payments, checking on the status of claims and handling prior authorization processes.

Its research concluded that despite the potential rewards, the medical and dental practices made only a modest level of progress in automating claims and related business processes over the past year. According to CAQH calculations, practices are still leaving roughly $11.1 billion in savings on the table, an estimate which has climbed by $1.8 billion over the prior year.

If these savings are realized, the majority ($9.5 billion) would end up in providers’ hands. However, many practices just haven’t gotten there yet.

A rise in portal use is certainly an improvement over paper-based claims processes. In fact, some of the increase in potential savings noted by the study is being created by a rise in online portal use.

However, providers’ adoption of fully-electronic claims is basically growing only a small amount or even declining for most transactions that can be done via a portal. For example, for prior authorizations, a big increase in portal use correlated with the decline in the adoption of fully-electronic transactions.

For CAQH, the endgame is getting all providers to automate claims processes complete, so the modest to flat growth in automated claims transactions is not exactly good news. In fact, it’s not a winning situation for medical practices either. According to the group’s estimates, each manual transaction costs practices $4.40 more than each electronic transaction and eats up five more minutes of provider time, which can create a real drag on profits.

Meanwhile, processing a single claim electronically through its lifecycle would save medical practices almost 40 minutes on average, and more than $15 in direct cost savings. Meanwhile, processing a single dental claim from start to finish could save dental practices almost 30 minutes on average and almost $11.75.

The CAQH press release doesn’t spell out what’s holding dentists and doctors back from automating the claims process completely, but it’s not hard to guess was going on. Unlike some providers, medical and dental practices typically don’t have deep pockets or large staff they can make this transition. If health plans want these providers to get on board, they’ll probably have to help them make the transition. However, even health plans haven’t invested in automated claims processing enough either.

Payers Say Value-Based Care Is Lowering Medical Costs, But Tech Isn’t Contributing Much

Posted on June 22, 2018 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.

A new survey of health insurers has concluded that while value-based care seems to be lowering healthcare costs significantly, they aren’t satisfied with the tools they have to analyze value-based performance.

The report, which draws on a survey sponsored by Change Healthcare, including answers from 120 payers across several types of insurance, including managed Medicare, managed Medicaid and commercial plans.

The topline finding from the report was that value-based care (VBC) has lowered healthcare costs by 5.6% on average, with one-quarter of respondents reporting savings of more than 7.5%.

Meanwhile, the volume of fee-for-service payments has dropped dramatically as a percent of overall payments, now accounting for just 37.2% of all reimbursement among respondents. That number is expected to fall below 26% by 2021.

Not only that, 64% of payers said that provider relationships improved, and 73% said patient engagement improved. This suggests that providers have made some strides in delivering value-based care, as many had a hard time restructuring their business in the past.

That said, some payers haven’t met their own VBC goals. In particular, 66% of payers are investing administrative staffers to support episode-of-care programs given what the study terms “exceptional” medical cost savings. Also, one third to one-half said that episode-of-care models were either very or extremely effective at improving care quality.

However, payers haven’t made much progress as they’d like in rolling out episode-of-care programs. While 21% of payers said they were capable of rolling out a new episode-of-care program in 3 to 6 months, more than a third said the needed a year to launch such a program, 21% said it would take 18 months, and 13% said it would take up to 24 months or more. In other words, many payers are so far behind the curve that the programs they’re designing might be obsolete by the time they roll them out.

What’s more, they’ve had a tough time getting providers interested in episode-of-care programs. Forty-three to 58% reported that it is either very or extremely difficult to get providers to participate in these efforts. Not only that, even when they find interested providers, payers are having a hard time finding common ground with them on episode definitions, budgets, the details of risk and reward sharing and performance metrics. These disagreements could prove a major hurdle to overcome.

In addition, more than half of payers said they were not very satisfied with the current value-based analytics, automation and reporting tools, even though most of the tools were developed in-house by the payers themselves. It could be that given provider resistance, the payers aren’t quite sure about what to look for. Regardless, it seems that payers have a longer-than-expected road to travel here.

AMA Says Med Students Don’t Get Enough EHR Training

Posted on June 20, 2018 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.

Whether or not doctors like it, the U.S. healthcare industry has embraced EHR technology, and in most cases, medical groups depend on it for a number of reasons. Now, the industry may be taking the next step in this direction, with the AMA deciding that it’s time to enshrine EHR use as part of medical education.

At its recent annual meeting, the AMA released a new policy embracing two somewhat contradictory notions. On the one hand, it encouraged med schools to train students on using EHR technology, while on the other, underscored the need for future doctors to get their faces out of the computer screen and engage with patients.

According to the trade group, some medical schools actually limit student access to EHRs. The AMA contends that this is a bad idea. “Medical students and residents need to learn how to ensure quality clinical documentation within an electronic health record,” said AMA board member and medical student Karthik Sarma in a prepared statement. “There is a clear need for medical students to have access to – and learn how to properly use – EHRs well before they enter practice.”

That being said, the group’s report on this subject concedes that there’s a long way to go in making this happen. For example, it notes that many med school faculty members aren’t offering students and residents much of a role model for the appropriate use of and practices in working with EHRs.

To address this problem, the new policy urges medical schools and residency programs to design clinical documentation and EHR training. It also recommends that the training be evaluated to be sure that it’s useful for future medical practice.

The AMA also suggests that med schools and residency programs provide faculty members with EHR professional development options. These lessons will help faculty serve as better role models on EHR use during interactions between physicians and patients.

That being said, there is an inherent tension between these goals and the realities of EHR use. Yes, training students to create good clinical documentation makes sense. At the same time, there are good reasons to worry about the effects of EHRs on student and resident relationships with patients. Unfortunately, this problem seems to be unavoidable as things stand today. Either you train budding physicians to be clinical documentation experts or you encourage them to use EHRs as little as possible during patient encounters.

In short, we’ve already learned that we can’t have both at the same time. So what’s the point of telling medical students that they should try to do the impossible?