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Medicare ACOs May Be Slated For Big Changes — And Health IT May Be Part Of It

Posted on May 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.

Before I get started, I want to offer a hat tip to Becker’s Hospital Review, which turned me onto the following news. That news, in brief, is that CMS might make changes to its ACO program that could have a big impact on the doctors and hospitals that participate.

According to Becker’s, CMS Administrator had some negative things to say about so-called “upside only” risk contracts, which don’t pay out anything to the agency if they miss financial and clinical benchmarks: “These ACOs are actually increasing Medicare spending, and the presence of these ‘upside-only’ tracks may be encouraging consolidation in the marketplace, reducing competition and choice for beneficiaries,” Verma told the AHA’s Annual Membership Meeting earlier this month.

At present, a whopping 460 of 561 ACOs in the Medicare Shared Savings Program are in Track 1, the agency’s upside-only program. At present, ACOs can only participate in two three-year contracts on this track, so next year 82 ACOs will be required to take on financial risk. Obviously, they don’t like this.

However, CMS isn’t exactly being unreasonable to consider curtailing Track 1. Looked at one way, the Medicare Shared Savings Program has failed utterly achieving its core purpose, and upside-only contracts are the primary reason.

According to Becker’s, which cited research from Avalere, while the program was supposed to generate $1.7 billion in net savings from 2013 to 2016, upside-only contracts were responsible for $444 million in federal spending. On the other hand, downside-risk ACOs cut spending by $60 million, a relatively tiny number when you consider the scale of CMS’s budget but positive side nonetheless.

All that being said, let me interject here and note that HIT may be part of the problem. I’m betting some of the expected savings was based on assumptions about how health IT would help ACOs meet clinical and financial benchmarks.

After all, the federal government spent many billions of dollars paying doctors and hospitals Meaningful Use incentive, which obviously gave them a convincing reason to adopt EMRs. No one approves that level spending without believing it would make everything better.

As it turns out, though, that might have been a flawed assumption. If I’m right, the Track 1 failure suggests that health IT isn’t doing as much to create efficiencies as federal health leaders had hoped. I know, particularly if you’re a doctor reading this, you’re saying “I could’ve told you this a decade ago.” Still, it’s worth repeating.

While health IT organizations — especially those housed in progressive health systems — are making great progress with improving care, we haven’t met the lofty goals of such approaches by any means. But if they want to progress toward value-based care, they’ll probably have to put their health IT to better use.

Competition Heating Up For AI-Based Disease Management Players

Posted on May 21, 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.

Working in collaboration with a company offering personal electrocardiograms to consumers, researchers with the Mayo Clinic have developed a technology that detects a dangerous heart arrhythmia. In so doing, the two are joining the race to improve disease management using AI technology, a contest which should pay the winner off handsomely.

At the recent Heart Rhythm Scientific Sessions conference, Mayo and vendor AliveCor shared research showing that by augmenting AI with deep neural networks, they can successfully identify patients with congenital Long QT Syndrome even if their ECG is normal. The results were accomplished by applying AI from lead one of a 12-lead ECG.

While Mayo needs no introduction, AliveCor might. While it started out selling a heart rhythm product available to consumers, AliveCor describes itself as an AI company. Its products include KardiaMobile and KardiaBand, which are designed to detect atrial fibrillation and normal sinus rhythms on the spot.

In their statement, the partners noted that as many as 50% of patients with genetically-confirmed LQTS have a normal QT interval on standard ECG. It’s important to recognize underlying LQTS, as such patients are at increased risk of arrhythmias and sudden cardiac death. They also note that that the inherited form affects 160,000 people in the US and causes 3,000 to 4,000 sudden deaths in children and young adults every year. So obviously, if this technology works as promised, it could be a big deal.

Aside from its medical value, what’s interesting about this announcement is that Mayo and AliveCor’s efforts seem to be part of a growing trend. For example, the FDA recently approved a product known as IDx-DR, the first AI technology capable of independently detecting diabetic retinopathy. The software can make basic recommendations without any physician involvement, which sounds pretty neat.

Before approving the software, the FDA reviewed data from parent company IDx, which performed a clinical study of 900 patients with diabetes across 10 primary care sites. The software accurately identified the presence of diabetic retinopathy 87.4% of the time and correctly identified those without the disease 89.5% of the time. I imagine an experienced ophthalmologist could beat that performance, but even virtuosos can’t get much higher than 90%.

And I shouldn’t forget the 1,000-ton presence of Google, which according to analyst firm CBInsights is making big bets that the future of healthcare will be structured data and AI. Among other things, Google is focusing on disease detection, including projects targeting diabetes, Parkinson’s disease and heart disease, among other conditions. (The research firm notes that Google has actually started a limited commercial rollout of its diabetes management program.)

I don’t know about you, but I find this stuff fascinating. Still, the AI future is still fuzzy. Clearly, it may do some great things for healthcare, but even Google is still the experimental stage. Don’t worry, though. If you’re following AI developments in healthcare you’ll have something new to read every day.

Nurse Satisfaction With EHRs Rises Dramatically, But Problems Remain

Posted on May 18, 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 the past, nurses despised EHRs as much as doctors did – perhaps even more. In fact, in mid-2014, 92% of nurses surveyed weren’t satisfied with the EHR they used, according to a study by Black Book Research. But things have changed a lot since then, Black Book says. The following data is focused largely on hospital-based nursing, but I think many of these data points are relevant to medical practices too.

Despite their previous antipathy to EHR’s, as of Q2 2018, 96% of nurses told Black Book that they wouldn’t want to go back to using paper records. That score is up 24% since 2016, the research firm reports.

Part of the reason the nurses are happier is that they feel they’re getting the technical support they need. Eighty-eight percent of responding nurses said that their IT departments and administrators were responding quickly when they asked for EHR changes, as compared with 30% in 2016.

On the other hand, the study also noted that when hospitals outsource the EHR helpdesk, nurses don’t always like the experience. Twenty-one percent said their experience with the EHR’s call center didn’t meet their expectations for communication skills and product knowledge. On the other hand, that’s a huge improvement from 88% in 2016.

Not only that, RNs are eager to improve their EHR skillsets. Most nurses are now glad that they are skilled at using at least one EHR, and 65% believe that persons who are skilled at working with multiple systems are seen as highly-desirable job candidates by health systems.

Providers’ choice of EHR can be an advantage for some in attracting top dressing talented. Apparently, RNs are beginning to choose job openings for the EHR product and vendor the provider uses as an indication of how the working environment may be than the provider itself. Eighty percent of job-seeking RNs reported that the reputation of the hospital’s EHR system is one of the top three considerations impacting where they choose to work.

That being said, there are still some IT issues that concern nurses. Eighty-two percent of nurses in inpatient facilities said they don’t have computers in each room or handheld/mobile devices they can use to access the EHR. That number is down from 93% in 2016, but still high.

These statistics should be of great interest to both hospitals and physicians. Obviously, hospitals have an institutional interest in knowing how nurses feel about their EHR platform and how they supported. Meanwhile, while most average size practices don’t address the same IT issues faced by hospitals, it benefits them to know what their nurses are looking for in a system. There’s much to think about here.

How Will CMS Handle Issues Surrounding MACRA Changes?

Posted on May 14, 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.

As most readers will know, when CMS released details on MIPS and the Alternative Payment Model incentives it embarked on a new direction for quality programs generally. As most readers will know, MIPS consolidated PQRS, the Physician Value-based Modifier and the Medicare EHR Incentive Program for EPs (Meaningful Use). But CMS is still updating the Medicaid incentive program.

If I were a physician, I’d be even more interested in the CMS initiative dubbed Promoting Interoperability. In some of the biggest news to come out of the agency in ages, CMS is restructuring the EHR Incentive Programs to become the Promoting Interoperability Programs. Promoting Interoperability replaces the Advancing Care Information category of MIPS.

Whoa. That would be a big enough deal on its own, but the issues the rule raises are an even bigger one.

CMS’s has been working towards this goal for a few years. Per HIMSS, here are some changes suggested in the proposed rule that might have the biggest impact on the health IT world:

  • The rule would cut down measures from 16 to six
  • It would use a new performance-based scoring methodology which would include measures of performance on e-prescribing, health information exchange, provider to patient exchange and public health and clinical data exchange
  • The agency will define and work to prevent “information blocking”

On a related note, CMS has posted a request for information asking for stakeholder feedback on program participation conditions. This is pretty unusual for the agency.

Like many CMS proposals, this one leaves some important questions open. (Apparently, CMS itself wonders how this thing will work, as the request for information suggests.)

For example, the new performance-based scoring method will award providers anywhere from 0 to 100 points. Measuring health IT performance is always a tricky thing to do, and there’s little doubt that if this becomes a final rule, both providers and CMS will have to go through some struggles before they perfect this approach. In the meantime, providers face some big challenges. How will they adapt to them? Its too soon to say.

Addressing so-called “information blocking” should be an even bigger challenge. Everyone from members of Congress to providers to vendors acts as though there’s one way to describe this practice, but there’s still a lot of wiggle room. Honestly, I’ll be amazed if CMS manages to pin it down the first time around.

Still, the time is more than overdue for CMS to take on interoperability directly. Without real data interoperability, many promising digital health schemes will collapse under their own weight. If CMS can figure out how to make it happen, it will be pretty neat.

Meaningful Use Becomes Advancing Care Information Becomes Promoting Interoperability – MACRA Monday

Posted on May 7, 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.

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.

I’m quite sure you’ve all seen the news coming out from CMS about the name change for the various Medicare EHR Incentive and MACRA programs. I decided to not dive into it in depth here since so many organizations are already doing it. Plus, this is just the proposed rule. However, if you want some light reading, here’s all 1883 pages of the Promoting Interoperability proposed rule.

The name change of Meaningful Use/Advancing Care Information to Promoting Interoperability is an interesting way for CMS to signal what they want these programs to accomplish. It’s always been clear that ONC has wanted to find a way to promote interoperability. Now they literally have a program that will work to drive that goal.

I’ll admit that I’ve been a fan of this idea since May 15, 2014 when I suggested that ONC and CMS blow up meaningful use and just focus it on interoperability. It only took 4 years for them to figure this out.

While I still think this is directionally an interesting way to go, I’m afraid that the current programs aren’t a big enough incentive for CMS to really move the needle on interoperability. Plus, can CMS really create a rule that would push effect interoperability? I’m skeptical on both counts.

What’s interesting is that CMS could really push interoperability if it wanted. It could just say, if you want to get paid for Medicare, then you have to start sharing data. No doubt there are some complexities to this idea, but if CMS is really serious about promoting interoperability, that’s what they’d really do. That would move the needle much better than thousands of pages of rule making that won’t cause doctors and healthcare organizations to change.

What are your thoughts on the proposed rule? Were there big pieces of it that you saw and you think others should be watching? Are these changes going to relieve doctors of the massive reporting burden they should today? Please share your thoughts in the comments or on Twitter with @HealthcareScene

Giving Patients Test Results: Is It A Good Idea?

Posted on May 2, 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, the conventional wisdom is that sharing health data with patients increases their engagement, which then improves their health.  And certainly, that may well be the case. I can tell you that when one of my doctors refused to share lab data until he reviewed it, I chewed his practice manager out. (Not very nice, I realized later.)

Still, I was intrigued by a story in the Washington Post challenging the idea that sharing test results is always a good idea. The story argues that in some cases, sharing data with patients lead to confusion and fear, largely because the patient usually gets no guidance on what the results mean. They may not be prepared to receive this information, and if they can’t reach their doctor, they might panic.

According to a source quoted in the Post, virtually no one knows what the actual benefits and risks are associated with releasing test results. “There is just not enough information about how it should be done right,” said Hardeep Singh, an associate professor at Baylor College of Medicine who studies patients’ experiences in receiving test results from portals. “There are unintended consequences for not thinking it through.”

Despite these concerns, some healthcare providers have decided to release most test results, gambling that this will pay off over the long-term. One such provider is Geisinger Health System. Geisinger releases test results twice a day, four hours after the data is published through a portal. ‘The majority [of patients] want early access to the results, and they don’t want to be impeded,” said Ben Hohmuth, Geisinger’s associate chief medical informatics officer at Geisinger.

Geisinger’s bet may help it avoid needless patient harm. According to a study appearing in JAMA, between 8% and 26% of abnormal test results – including potential malignancies – aren’t followed up on in a timely matter. Giving them this data allows them to react quickly to abnormal test results and advocate for themselves.

It also seems that the Washington Post didn’t take the time to get to know CT Lin, CMIO at University of Colorado Health. He’s done extensive research into providing electronic access to results and other health data. His results are clear and cover the idea that releasing some results is harmful. There are a few results that are good to keep until the provider has talked to the patient. However, he found across a wide range of examples that releasing the results doesn’t cause any of the damages that many imagine in their minds.

Maybe its time for providers to begin studying patient responses to test result access even more. We’re not talking rocket science here. You could start with an informal survey of patients visiting one of your primary care clinics, asking them whether they use your portal and which features they consider most valuable.

If patients don’t rate access to test results highly, it doesn’t mean that you shouldn’t bother making them available.  It could be that at the moment, your test results aren’t displayed in a useful manner, or that the patients you talk with dislike the portal overall. We can work to learn this as well rather than imagining some scenario that could go bad. That’s easy in healthcare.

Regardless, the evidence suggests that at least some patients benefit from having this data, especially the ability to ask good questions about their health status. For the time being, that’s probably a good enough reason to keep the data flowing.

Setting Work Limits, Slow EMR Access, and Good, Better, and Best Data

Posted on April 30, 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.

It’s that time once again for a roundup of interesting tweets. There are always thousands more that we could highlight, so if you’re not on Twitter, why not? It takes some investment to get the best feed possible, but once you do it’s invaluable. Of course, we do our best here at Healthcare Scene to read everything so you don’t have to. So, at least we have you covered there.

Now on to the fun…


This is a fine point that is worthy of more discussion. Of course, it’s a universal problem that doesn’t just apply to healthcare. It’s worth noting that this doctor didn’t comment about the times she had to race into the office to look up a paper chart either because she got a call about a patient that was in the ER. As in most things in life, there’s a lot of give and take. Setting limits is really the key because the accessibility of records can save a lot of time too.


This is an interesting one for me. There are some real red flags here. First, if they’re using Citrix, then it’s likely not a true cloud implementation and likely means it’s an older EMR software. Not always true, but quite possible. Second, if the workflow is to print a list so they can write notes with a pencil, then they have some serious EHR implementation, adoption, and optimization problems. Is the optimal workflow a pencil and paper? My guess is not. However, the fact that the machine boots up slow probably indicates that this user doesn’t have great tech support that can show them a better way. Unfortunately, I think that this is probably all too common too.


Rasu offered some great insights into data at Health Datapalooza. This was a golden one that I could tell he’d shared quite a bit. How many of you work in organizations that turn data into action?

AI Software Detects Diabetic Retinopathy Without Physician Involvement

Posted on April 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.

The FDA has approved parent company IDx to market IDx-DR, the first AI technology which can independently detect diabetic retinopathy. The software can make basic recommendations without any physician involvement.

Before approving the software, the FDA reviewed data from a clinical study of 900 patients with diabetes across 10 primary care sites. IDx-DR accurately identified the presence of diabetic retinopathy 87.4% of the time and accurately identified those without the disease 89.5% of the time. In other words, it’s not perfect but it’s clearly pretty close.

To use IDx-DR, providers upload digital images of a diabetic patient’s eyes taken with a retinal camera to the IDx cloud server. Once the image reaches the server, IDx-DR uses an AI algorithm to analyze the images, then tells the user whether the user has anything more than mild retinopathy.

If it finds significant retinopathy, the software suggests referring the patient to an eye care specialist for an in-depth diagnostic visit. On the other hand, if the software doesn’t detect retinopathy, it recommends a standard rescreen in 12 months.

Apparently, this is the first time the FDA has allowed a company to sell a device which screens and diagnoses patients without involving a specialist. We can expect further AI approvals by the FDA in the future, according to Commissioner Scott Gottlieb, MD. “Artificial Intelligence and Machine Learning hold enormous promise for the future of medicine,” Gottlieb tweeted. “The FDA is taking steps to promote innovation and support the use of artificial intelligence-based medical devices.”

The question this announcement must raise in the minds of some readers is “How far will this go?” Both for personal and clinical reasons, doctors are likely to worry about this sort of development. After all, putting aside any impact it may have on their career, they may be concerned that patient will get short-changed.

They probably don’t need to worry, though. According to an article in the MIT Technology Review, a recent research project done by Google Cloud suggests that AI won’t be replacing doctors anytime soon.

Jia Li, who leads research and development at Google Cloud, told a conference audience that while applying AI to radiology imaging might be a useful tool, it can automate only a small part of radiologists’ work. All it will be able to do is help doctors make better judgments and make the process more efficient, Li told conference attendees.

In other words, it seems likely that for the foreseeable future, tools like IDx-DR and its cousins will help doctors automate tasks they didn’t want to do anyway. With any luck, using them will both save time and improve diagnoses. Not at all scary, right?

AI Tool Helps Physician Group Manage Prescription Refills

Posted on April 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.

Most of the time, when we hear about AI projects people are talking about massive efforts spanning millions of records and many thousands of patients. A recent blog item, however, suggests that AI can be used to improve comparatively modest problems faced by physician groups as well.

The case profiled in the blog involves Western Massachusetts-based Valley Medical Group, which is using machine learning to manage medication refills. The group, which includes 115 providers across four centers, implemented a product known as Charlie, a cloud-based tool made by Healthfinch 18 months ago. (I should note, at this point, that the blog maintained is by athenaHealth, which probably has a partnership with Healthfinch. Moving on…)

Charlie is a cloud-based tool which automates the process of prescription refills by integrating with EHRs. Charlie processes refill requests much like a physician or pharmacist would, but more quickly and probably more thoroughly as well.

According to the blog item, Charlie pulls in refill requests from the practice’s EHR then adds relevant patient data to the requests. After doing so, Charlie then runs the requests through an evidence-based rules engine to detect whether the request is in protocol or out of protocol. It also detects duplicates. errors and other problems. Charlie can also absorb specific protocols which let it know what to look for in each refill request it processes.

After 18 months, Valley’s refill process is far more efficient. Of the 10,000 refill requests that Valley gets every month, 60% are handled by a clerical person and don’t involve a clinician. In addition, clerical staff workloads have been cut in half, according to the practice’s manager of healthcare informatics.

Another benefit Valley saw from rolling out Charlie with that they found out which certain problems lay. For example, practice leaders found out that 20% of monthly refill requests were duplicate requests. Prior to implementing the new tool, practice staff spent a lot of time investigating the requests or worse, filling them by accident.

This type of technology will probably do a lot for medium-sized to larger practices, but smaller ones probably can’t afford to invest in this kind of technology. I have no idea what Healthfinch charges for Charlie, but I doubt it’s cheap, and I’m guessing its competitors are charging a bundle for this stuff as well. What’s more, as I saw at #HIMSS18, vendors are still struggling to define the right AI posture and product roadmap, so even if you have a lot of cash buying AI is still a somewhat risky play.

Still, if you’re part of a small practice that’s rethinking its IT strategy, it’s good to know that technologies like Charlie exist. I have little doubt that over time — perhaps fairly soon — vendors will begin offering AI tools that your practice can afford. In the meantime, it wouldn’t hurt to identify processes which seem to be wasting a lot of time or failing to get good results. That way, when an affordable tool comes along to help you’ll be ready to go.

Making EHRs Easier to Use and Safer

Posted on April 23, 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.

Most people know that I’m a sucker for a well done infographic. Of course, there are a lot of crappy infographics out there, but a well done one is easy to read, educates, and informs in a really nice way. That’s why I enjoyed this infographic from The PEW Charitable Trusts embedded below.

Some of the EHR usability it issues are well known things like alert fatigue and incomplete lab results. However, I was impressed that this list included things that are often hidden from many’s view like the unintended consequences of customization and autorefresh mix-ups. Of course, the infographic doesn’t talk about how to fix them, but in many of these cases awareness is what’s most needed to fix the problem.

What do you think of the infographic below? What stands out to you?