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Is EHR Use Causing Physician Burnout?

Posted on November 12, 2018 I Written By

The following is a guest blog post by Wayne Crandall, President & CEO of NoteSwift.

Over the past decade, numerous studies have been published with the same concerning conclusion – physicians are increasingly expressing feelings of burnout, frustration, and a lack of support from their employers and technology solutions. There is no single cause for this burnout, but there are plenty of signals pointing to a primary cause:

EHR use, requirements, and regulations are leading to incredibly high levels of physician burnout.

The data is increasingly clear on this issue. Consider this statistic: according to a 2015 survey, almost 90% of doctors feel moderately to severely stressed and burned out on an average workday.

And this one: A new study by the University of Wisconsin and the American Medical Association (AMA) found primary care physicians spend almost six hours (5.9) on EHR data entry during a typical 11.4 hour workday.

Because of this rapid rise in physician burnout and clear connection to EHR use and management, we decided to look more deeply into the causes, symptoms, and possible solutions to the physician burnout crisis. The result of this research is a newly published white paper we’ve created in partnership with Dr. Robert Van Demark, Jr., a leading voice on the issue of physician burnout.

In this paper, you’ll find the following:

  • Compilation of recent data and studies on the symptoms and causes or physician burnout.
  • Researching connecting physician burnout to employee retention
  • Examination of how EHR use contributes to the burnout crisis
  • A look ahead to emerging solutions to this crisis

There are many compelling examples for why this research is more timely and important than ever. In a time where many physicians are questioning whether the burnout, stress, and anxiety are worth it, health care systems are reporting massive costs for recruiting and replacing doctors who leave due to burnout and overwork. The stakes could not be higher for health systems, doctors, and patients who need access to expert care.

The paper also takes a closer look at the innovative world of artificial intelligence and how it holds much promise for improving health care and EHR entry through automation and understanding. At a time where physicians are looking for more ways to control their workflow and create better, more efficient care for patients, the world of artificial intelligence is leading the way toward better solutions and better care.

I was recently reading a helpful LinkedIn article on the topic of physician burnout, and the author noted how many practices and health care systems focus on treating the symptoms of physician burnout instead of treating the actual cause of this burnout. More meetings, more committees, more work for doctors, while the underlying causes go untreated. EHRs are a primary cause of this burnout, and we believe that finding a better way to handle our EHR work is major way we can improve workflows and reduce physician burnout. Hopefully this white paper can lead the conversation in that direction.

To receive your complimentary copy of this white paper, “Physician Burnout By The Numbers,” click here. You’ll receive instant access to the paper as a resource for you and your team.

About Wayne Crandall
Wayne Crandall’s career in technology spans sales, marketing, product management, strategic development and operations. Wayne was a co-founder, executive officer, and senior vice president of sales, marketing and business development at Nuance Communications and was responsible for growing the company to over $120M following the acquisition of Dragon and SpeechWorks.

Prior to joining the NoteSwift team, Wayne was President and CEO of CYA Technologies and then took over as President of enChoice, which specialized in ECM systems and services, when they purchased CYA.

Wayne joined NoteSwift, Inc. at its inception, working with founder Dr. Chris Russell to build the team from the ground up. Wayne has continued to guide the company’s growth and evolution, resulting in the development of the industry’s first AI-powered EHR Virtual Assistant, Samantha(TM).

NoteSwift is the leading provider of EHR Virtual Assistants and a proud sponsor of Healthcare Scene.

Problematic Medical Bills Drive Consumers To Cut Back On Care

Posted on November 7, 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 we all know, patients and families are taking over responsibility for a steadily greater percentage of their healthcare costs over time. Not surprisingly, this can affect their medical decisions in negative ways. In fact, a new study has documented that their medical bills are confusing or unexpected, a patient may get overwhelmed and simply skip some forms of care entirely.

The study, which was conducted by Hanover Research and sponsored by HealthSparq, surveyed more than 1,000 Americans on their experiences with unexpected medical bills. The results should be unsettling to anyone in outpatient services, especially those in primary care.

Researchers found that more than half (53%) of respondents had received a surprise medical bill over the past 12 months. This included bills that were higher than expected (60%), for services they thought were covered by insurance but weren’t (62%) and from multiple providers when they expected to get just one (42%).

When faced with these frustrating billing situations, patients may drop out of their care routine to some extent. Many skip routine checkups (40%), routine health screenings (39%) or care for injuries (39%).

A substantial number of respondents (40%) conceded that they could’ve avoided such shocks by doing more to better understand their benefits and healthcare processes, in addition to blaming their insurers (45%) or their health providers (42%). Regardless, it appears that a large number didn’t know who was responsible for the problem, which doesn’t bode well for their future health behavior.

Look, everyone knows that offering an accurate estimate of patient financial liabilities could be a nightmare in some situations, particularly if insurance companies don’t play nicely with the billing department. It’s also true that in some cases, patients simply won’t be able to pay the bill regardless of how you present it, a problem you certainly can’t surmise on your own as a medical practice.

That being said, you can take a look at the bills your practice management system produces and get a sense whether they’re decipherable to those who don’t work within the organization. Even if the PM system does a good job of supporting your end of the process, that doesn’t mean it’s turning out bills that patients can use and understand.

Yes, arguably the most important thing a practice management system does is to support your claims process effectively, but seeing to it that patients aren’t overwhelmed by their bills is clearly a big deal too. Particularly under value-based care, you can’t afford to have them holding off on the services that will keep them well.

2019 MACRA Final Rule Overview

Posted on November 5, 2018 I Written By

The following is a guest blog post by Joy Rios, Health IT Consultant at Chirpy Bird.

It happened right on time this year. The 2019 MACRA Final Rule was released on Thursday, Nov. 1, the weekend of Daylight Savings Time – so those of us who track these laws carefully got one extra hour to read through the 2878-page document. Thanks CMS!

First, I’d like to point out that we expect the rules to change each year. If fact, my colleague, Robin Roberts, and I often joke that CMS starts writing the next rule before the ink is dry on the one they just released. However, this year it feels like there’s a lot more to get up to speed on than that which we’ve grown accustomed.

The expansion of the rule’s title alone, which is both comprehensive and overwhelming, hints that this year’s ruling is far-reaching and will impact a great many stakeholders across healthcare.

Look for yourself: The difference between the proposed and finalized titles:

Proposed Title:

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program

Finalized Title:

Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program–Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions from the Medicare Shared Savings Program–Accountable Care Organizations–Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act

The subtitles from the Finalized rule that I reviewed are broken out below with the main bullet points:

1. Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019

  1. Supports access to care using telecommunications technology.
  2. Medicare will pay providers for new communication technology-based services, such as brief check-ins between patients and practitioners, and pay separately for evaluation of remote pre-recorded images and/or video.
  3. CMS is also expanding the list of Medicare-covered telehealth services.
  4. CMS is delaying implementation of E&M coding reforms until 2021.

“Physicians will see some immediate changes in 2019 that reduce burden and even more significant burden reduction in 2021, when broader changes to the E&M framework take effect,” said Seema Verma.

2. Quality Payment Program

a. MIPS: 2019 Performance Year

General Program Changes

  1. Amount at risk to Medicare Part B services:
    1. Max 7% penalty
    2. 7x incentive, which could result in an adjustment above or below 7%
  2. Avoid a penalty: 30 points (double the 2018 threshold of 15)
  3. Earn Exceptional Performance to capture part of the $500M bonus pool: 75 points (up from 70 in 2017 & 2018)
  4. Expansion of Eligible Clinician types:
    1. PT, OT, Speech & Language, Audiologists, Clinical Psychologists, Registered Dieticians/Nutrition Professionals
  5. Low-volume threshold now includes a third criterion. To be excluded from MIPS, clinicians or groups need to meet one or more of the three criterion.
  6. New Opt-in policy for clinicians or groups who meet or exceed at least one, but not all three of the low-volume threshold criteria.
  7. Virtual Groups must designate a representative and email election to MIPS_VirtualGroups@cms.hhs.gov by Dec. 31, 2018 for the 2019 performance year.
  8. Finalizing a policy to assign a weight of 0% to each of the four performance categories and a final score equal to the performance threshold when:
    1. A MIPS eligible clinician joins an existing practice (existing TIN) in the final three months of the performance period year and the practice is not participating in MIPS as a group
    2. A MIPS eligible clinician joins a practice that is a newly formed TIN in the final three months of the performance period year
  9. Small practice bonus 5 to 6, but applied at the Quality Category level, rather than being applied to overall CPS.

Category Changes

Quality

  1. Category weight: 45%
  2. Different quality measures may now be submitted via different collection types. For example, a group or clinician may submit some measures through an EHR and some through a QCDR, and the measures will be scored together as part of one set.
  3. Claims can be reported by individuals or groups (again), but only by clinicians in a small practice (15 or fewer ECs)
  4. Groups who report 5 or fewer quality measures and do not meet the CAHPS for MIPS sampling requirements, will have their quality denominator reduced by 10 and the missing measure will receive zero points
  5. NEW: Extremely Topped-Out Measures: A measure attains this status when the average mean performance is within the 98th to 100th percentile range. Such measures will be proposed for removal in the next rule-making lifecycle for other topped-out measures.
    1. QCDR measures are excluded from the topped-out measure life cycle.

Promoting Interoperability

  1. Category weight: 25%
  2. Requires 2015 Edition CEHRT
  3. Two new measures: Opioid Treatment Agreement & Query of PDMP
  4. PI Score based on a single, smaller set of measures, no longer divided into Base, Performance, and Bonus

Cost

  1. Category weight: 15%
  2. Adding 8 new episode-based measures
    1. Case minimum 10 for procedural episodes
      1. CMS will attribute episodes to each MIPS EC who renders a trigger service
    2. Case minimum 20 for acute inpatient medical condition episodes
      1. CMS will attribute episodes to each MIPS EC who bill inpatient E&M claim lines during a trigger inpatient hospitalization under a TIN that renders at least 30% of the inpatient E&M claim lines in that hospitalization

Improvement Activities

  1. Category weight: 15%
  2. Added 6 new activities, modified 5 existing activities, removed 1 activity

b. APM Performance Year 2019

  1. Several references to 2025 and beyond
  2. CEHRT requirements of Advanced APMs: 75% of Eligible Clinicians in each APM Entity
  3. Other Payer Advanced APMs: 75% beginning in 2020
  4. Expanding the 8% revenue-based nominal amount standard for AAPMs and Other Payer AAPMs through 2024
  5. Quality – must report at least one outcome measure
  6. All-Payer Combo Option and Other Payer AAPMS
    1. Established a multi-year streamlined determination process where payers and Eligible Clinicians can provide info on the length of the agreement as part of their initial submission, and have any resulting determination be effective for the duration of the agreement (or up to 5 years)
    2. Allowing QP determinations at the TIN level, in addition to the APM Entity and individual EC levels
    3. Allowing all payer types to be included in the 2019 Payer Initiated Other Payer AAPM determination process for the 2020 QP performance period
  7. Multi-Year Other Payer AAPMs
    1. Payers and eligible clinicians with payment arrangements determined to be Other Payer Advanced APM must re-submit all information for CMS review and redetermination on an annual basis.
      1. At the time of the initial submission, the payer and/or eligible clinician will provide information on the length of the agreement, and attest at the outset that they will submit information about any material changes to the payment arrangement during its duration.
      2. In subsequent years, if there were no changes to the payment arrangement, the payer and/or eligible clinician do not have to annually attest that there were no changes to the payment arrangement
    2. Updated the MIPS APM measure sets that apply for purposes of the APM scoring standard

c. Public Reporting via Physician Compare

  1. Quality – all measure under MIPS Quality are available for public reporting, unless the measure itself is new (i.e. in its first or second year.)
  2. Cost – subset of Cost measures is available for public reporting, except new measures
  3. PI – Include an indicator for Eligible Clinician or group “successful” performance
  4. PI – include objectives, activities, and/or measures

3. Quality Payment Program–Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year;

CMS has had to respond to some hard-to-face realities* since the proposed rule was released in July. Of note, the first policy addition to the rulemaking provides relief for ACOs, in addition to other MIPS eligible clinicians affected by fires, hurricanes, natural or man-made disasters that have a significant negative impact on healthcare operations, area infrastructure or communication systems. They will have the option to self-attest and receive a hardship exception.

*Climate Change is real.

4. Provisions from the Medicare Shared Savings Program–Accountable Care Organizations–Pathways to Success;

This policy provides a new direction for the Shared Savings Program by establishing pathways to success through redesigning the participation options available under the program to encourage ACOs to transition to two-sided models, in which they may share in savings and are also accountable for repaying any shared losses.

It also offers to:

  1. Further promote interoperability
  2. Grant voluntary 6-month extension for existing ACOs whose participation agreements expire on Dec. 31, 2018.
  3. Align CEHRT with QPP

5. Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act

This policy outlines plans to reimburse physicians for virtually checking in with patients and remotely evaluating recorded images.

As it turns out, people treated remotely for psoriasis did just as well as those treated in person — and were much happier about not having to travel to see their doctors.

The final Medicare physician payment rule also expands payment for treatments for stroke, kidney disease, mental health and substance abuse by removing restrictions on originating sites. Those are all provisions from the budget and opioid packages.

************************

You could take any of these sections and write opinion pieces, draw dotted lines to affected stakeholders, and venture down about 1000 rabbit holes with this rule.

CMS Administrator Seema Verma acknowledges that transitioning to value-based care will require all of us to stretch and maybe sit with a bit of discomfort.

In her words, “If we’re going to move our system to a patient-centered, value-based system, change is inevitable, and change is always hard for those whose livelihood is dependent on the status quo.”

If you’re looking for some direction with MIPS, ACOs, or your place in the value-based care ecosystem, get in touch.

If you want to hear Robin and I geek out over this rule, be on the lookout for a special episode of the HIT Like a Girl podcast, to which you can subscribe here.

Lost EMR Data

Posted on October 24, 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.

More and more EMR data is being lost and this trend is just beginning. This is particularly true in the ambulatory space where ambulatory medical practices are being bought up left and right by health systems. In the vast majority of acquisitions, the acquired practice has to convert from their current EHR to the health system EHR. In that process, a few of them will convert some of the data, but in many cases, the health system leaves behind the data from the old EHR system. That data is lost.

Also, just to be clear, when I say the data is lost. It’s probably not fully lost. Most organizations continue to limp along the old system per the state records retention laws or they move it on to some archival solution. However, no one other than HIM has real access to the old system. If a doctor can’t easily access the data from the legacy EHR, then the data is lost from my point of view.

It’s a really unfortunate situation since much of that data has value that can impact the care being given to patients going forward. Plus, in the worst scenarios, the data is truly lost as the IT department sunsets an old system and doesn’t realize the proper way to retire a legacy system.

In a recent tweet, Galen Healthcare, experts in EHR data archiving, offered important insights into archiving old EMR and healthcare IT systems and highlighted some commonly missed data sets.

It’s amazing how many people forget the value and importance of things like a contextual audit trail. You’ll understand their value once you get a release of information request as part of a malpractice case. You don’t want to be there empty handed.

As EHR and other healthcare IT software matures and we start their replacement lifecycles, it’s going to be important that your organization has a detailed process for retiring old systems. You have to ensure your providers still have access to the clinical information they need, but that you also retain the other compliance information that protects your organization. Missing one or the other is a recipe for disaster.

Stanford Offers 10-Year Vision For EHRs

Posted on October 12, 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.

Despite many efforts to improve EHRs, few physicians see them as adding value to the practice. Sadly, it’s little surprise given that many vendors don’t worry much about what physicians want, focusing instead on selling features to CIOs.

As a result, they still don’t like their EHRs that much. In fact, a recent survey conducted by Stanford Medicine and the Harris Poll found that 44% of physicians said that the top value of the EHR was to serve as digital storage, which isn’t a ringing endorsement. Just eight percent saw the EHR as having clinical value, with three percent citing disease prevention, 2% clinical decision support and 3% patient engagement as top benefits.

Is it possible to create a new EHR model that physicians love? According to Stanford, we could build out an ideal EHR by the year 2028.

In Stanford’s vision, clinicians and other healthcare professionals simply take care of the patients without having to think about health records. Once examinations are complete, information would flow seamlessly to all parties involved, including payers, hospitals, physicians and the patient.

Meanwhile, it would be possible to populate the EHR with little or no effort. For example, an automated physician’s assistant would “listen” to interactions between the doctor and the patient and analyze what was said. Depending on what is said in the room, along with verbal cues of the clinicians, it would record all relevant information in the physical exam.

What’s more, the automated physician’s assistant would have AI capabilities, allowing it to synthesize medical literature, the patient’s history and relevant histories of other patients available in anonymized, aggregated form.

Having reviewed these factors, the system would then populate different possible diagnoses for the clinician to address. The analysis would take patient characteristics into account, including lifestyle, medication history, and genetic makeup.

In addition to its vision, the survey report offered some short-term recommendations on how medical practices can support physician EHR use. They included:

  • Training physicians well on how to use the EHR when they’re coming on board, as well as when there are incremental changes to the system
  • Involving physicians in the development of clinical workflows that take advantage of EHR capabilities
  • Delivering EHR development projects as quickly as possible once physicians request them
  • Making data analytics abilities available to physicians in a manner that can be used intuitively at the point of care
  • Considering automated solutions to eliminate manual EHR documentation

Technologists, for their part, can take also take immediate steps to support physician EHR use, including:

  • Developing systems and product updates in partnership with physicians
  • Limiting the use of manual EHR documentation by using AI, natural language processing and other emerging technologies
  • Using AI to perform several other functions, including synthesizing and summarizing relevant information in the EHR for each patient encounter and offering current and contextualized information to each member of the patient care team

In addition, to boost the value of EHRs over the long-term, 67% of physicians said making interoperability work was important, followed by improving predictive analytics capabilities (43%), and integrating financial information into the EHR to help patients understand care costs (32%).

Quality Payment Program Tops List Of Regulatory Burdens On Medical Practices

Posted on October 10, 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 by the Medical Group Management Association has found that meeting the demands of the Medicare Quality Payment Program tops the list of regulatory burdens named by respondents in medical practices.

The survey, which collected responses from 426 medical groups, found that their regulatory burdens were climbing, with 86% reporting that such burdens had increased over the past 12 months. A smaller but similar share of respondents (79%) reported that the overall regulatory burden associated with participating in Medicare specifically had increased during the same period.

When asked to name the regulatory requirements they considered to be very or extremely burdensome, 88% named the Quality Payment Program, followed by prior authorization (82%), lack of EHR interoperability (80%), government EHR requirements (77%) and audits/appeals (68%). In contrast, just 49% of respondents saw compliance with HIPAA privacy and security requirements to be a major concern.

Given the challenges it imposes on practices, it’s no wonder that the MGMA respondents struggle with MIPS, with just 9% stating that they were satisfied or very satisfied with the performance feedback the program offers. Two-thirds of respondents told the MGMA that at least in its current form, MIPS doesn’t support their practice’s clinical quality priorities.

Perhaps the most irksome aspects of the MIPS program seemed to be the full-year quality reporting period and scoring methodology. Roughly two-thirds of respondents were dissatisfied or very dissatisfied with these aspects of the program. “The lack of clarity and constant readjusting of the MACRA regulations regarding MIPS/APMs is also frustrating,” one group member said.

In addition, despite ongoing efforts to support patient data exchange, the percent of respondents who rated a lack of EHR interoperability as very or extremely burdensome has climbed over the last 12 months, from 68% last year to 80% in 2018.

Ultimately, this problem could have serious financial consequences for some organizations. “Interoperability will never be achieved at the rate we’re going without bankrupting most private medical practices,” wrote one respondent. “As each of the EHR vendors moves towards their own interpretation of interoperability, they create different versions of their own software that cost all of us more to implement and we can’t afford any more.”

If these issues aren’t addressed, it seems likely Medicare’s drive toward value-based payment will be less successful than its leaders would hope.  Seventy-nine percent of practices responding to the MGMA survey said they didn’t think the move toward value-based payment had been successful to date, and it doesn’t seem likely that this will change if physicians continue to feel overburdened and misunderstood

A Next Step For Personalized Medicine? Vendor Brings Genomics To Ambulatory EHR

Posted on October 8, 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 physicians have some sense of the value personalized medicine can bring to their practice, but I doubt that many have ready access to the tools they’d need to harness its power.

In an effort to close that gap – and of course, to make its platform irreplaceable – a vendor serving medical practices has struck a deal giving physicians the ability to order genetic tests and leverage them to improve care.

The vendor, DrChrono, offers a suite of electronic systems for physicians, including an EHR which can be customized by bundling in affiliated apps. Its new partner is Genomind, a personalized medicine platform offering genetic testing for psychiatry practices.

Physicians using DrChrono will have access to two Genomind test kits, along with some analytics tools they can use to make use of the testing data.

One of the tests is Mindful DNA Professional, a genetic test used by clinicians to help them guide wellness decisions. The test targets aspects of a patient’s genetic details which could have an impact on overall health, such as variants suggesting that they could have sleep issues or a predisposition to anxiety, depression or impaired cognition.

DrChrono users will also have access to the Genecept Assay, the results of which can guide the treatment of psychiatric conditions. Once test results become available on the Genomind system, doctors can use its gene-drug-environmental interaction tool, the Genomind Drug Interaction Guide, to inform their treatment decisions. With the help of the Guide, clinicians can analyze the patient’s current medication regimen and flag gene-drug interactions.

An interesting side note to all of this is that the final test results from Genomind will be stored in the DrChrono information library for the patient and become part of the patient’s medical record.

Looked at one way, sharing the Genomind test results seems almost like a no-brainer in a world where casual genetic testing (think 23andMe) is becoming the norm. On the other, though, I don’t want to gloss over the fact that using genetic data to search for relatives is one thing and putting it into your personal medical record is quite another. It suggests that of consumer-driven demand for precision treatment is maturing, and that Genomind is on the right side of this trend.

This takes me back to DrChrono, which while not itself reinventing the wheel has struck a smart deal here. Not only has it brought a tool on board which could offer some benefit to physicians, its supporting the collection of information (genetic data) that patients are beginning to want. If DrChrono can give patients their genetic info via a decent portal, the company may find itself to be in demand with patients. Way to stay abreast of the times.

Better Performing Practices Invest in Communications

Posted on October 1, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

MGMA’s Winning Strategies From Top Medial Groups report identifies better-performing practices have invested in: (1) New/upgraded EHRs; (2) Electronic communication systems; and (3) Upgraded coding and revenue cycle management systems.

The Medical Group Management Association (MGMA) released their Winning Strategies From Top Medical Groups report – on the morning of their annual conference. The report is based on data gathered from 3,000+ medical groups that were identified by MGMA as top-performers in at least one of four categories:

  1. Better-performing practices focus on using resources efficiently and create + stick to a financial plan.
  2. Better-performing practices are those whose providers and staff successfully contributed to earned revenue for the practice.
  3. Better-performing practices have lower operating costs as a percentage of revenue and manage their revenue cycle better.
  4. Better-performing practices report on quality metrics while also excelling in at least one other category.

According to the report, being a better-performer reaps significant benefits.

  • Better performing independently-owned surgical specialty practices have 20% lower operating costs vs other practices
  • Better performing primary care practices have 8.6% greater net income per physician vs other practices
  • Better performing practices collect 10% more accounts receivable in the first 30 days vs other practices

Overall, the report identified three key strategies that better-performing practices pursue:

  1. Building an engaging, patient-focused culture
  2. Focusing on long-term, strategic progress
  3. Constantly investing in improving operations

What was the most surprising result in the report? Todd Evenson, Chief Operating Officer of MGMA had this to say “I found it surprising how much more productive Better Performers were in terms of Work Relative Value Units (RVUs). Better-performing non-surgical specialty practices, for example, were found to have an average of 9,115 RVUs per physician compared to 7,300 for all other practices. The report highlights having the right staff, the right technology and the right people can make a big difference.”

For me, the most interesting aspect of the report was where HealthIT investments were being made. The report identifies that better-performers had or were planning to invest in:

  1. New or upgraded EHRs to support better patient communication, better provider experience and workflow efficiency
  2. Electronic communication systems (like secure texting) for use between providers and with patients
  3. Upgraded billing/coding software and revenue cycle management systems

I did not expect to see communication so prominent in the top Health IT priorities. For many years communication has been an afterthought. It is encouraging to see that in 2018 practice leaders are putting an emphasis on tools and systems to help bring the people who are delivering care closer to peers and closer to patients.

“The reality is, any practice can achieve top performance when the people within it make a sustained effort to do more of the right things well,” said Ken Hertz, Principal MGMA Consultant. “We developed this report not only to give practices strategies to get the most from their business but to show them that these efforts pay off—for practices and patients alike. When practices invest in improving their business, patients are more efficiently served, increasing patient satisfaction and health outcomes, and improving patient retention rates. It’s a feedback loop that benefits everyone.”

The Winning Strategies From Top Medical Groups report is available exclusively to MGMA members.

Practice’s EMR Implementation Drove Up Costs For Six Months

Posted on September 28, 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.

Everyone knows that providers incur EMR-related costs until well after it is implemented. According to a new study, in fact, one medical incurred higher costs for six months after its implementation.

The study, which appeared recently in The Journal of Bone & Joint Surgery, calculated the impact of an EMR implementation on labor costs and productivity at an outpatient orthopedic clinic. The researchers conducting the study used time-driven activity-based costing to estimate EMR-related expenses.

To conduct the study, the research team timed 143 patients prospectively throughout their clinic visit, both before implementation of the hospital system-wide EMR and then again at two months, six months and two years after the implementation.

The researchers found that after the first two months, total labor costs per patient had shot up from $36.88 to $46.04.

One reason for the higher costs was a growth in the amount of time attending surgeons spent per patient, which went up from 9.38 to 10.97 minutes, increasing surgeon cost from $21 to $27.01. In addition, certified medical assistants for spending what time assessing patients, with the time spent almost tripling from 3.42 to 9.1 minutes.

On top of all of this, providers were spending more than twice as much time documenting patient encounters as they had before, up to 7.6 minutes from 3.3 minutes prior to the implementation.

By the six-month mark, however, labor costs per patient had largely returned to their previous levels, settling at $38.75 compared with $36.88 prior to the installation, and expense which remain at the same level when calculated at two years after the EMR implementation.

However, providers were spending even more time documenting encounters than they had before the rolling, with time climbing to 8.43 minutes or roughly 5 minutes more than prior to the introduction of the EMR. Not only that, providers were spending less time interacting with patients, falling to 10.03 as compared with 14.65 minutes in the past.

Sadly, we might have been able to predict this outcome. Clearly, the clinic’s EMR implementation has burdened its providers and further minimized time the providers spend with their patients. This, unfortunately, is more of a rule than an exception.

So why did the ortho practice even bother? It’s hard to say. The study doesn’t say what the practice hoped to accomplish by putting the EMR in place, or whether it met those goals. Given that the system was still in place after two years one would hope that it was providing some form of value.

Truthfully, I’d much rather have learned about what the clinic actually got for its investment than how long it took to get everyone trained up and using it. To be fair, though, this data might have some relevance to the hospital systems that manage a broad spectrum of medical practices, and that’s worth something.

A Vote In Favor Of Using Scribes

Posted on September 26, 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.

Over the past few years, using scribes to complete medical documentation in EHRs has gotten mixed reviews. Some analyses have found that scribe services were too expensive to justify the investment, while others have concluded that the use of scribes can make a meaningful impact on revenue and improve physician productivity.

This month, a new paper has been published whose results fall into the plus column. The small study, which appears in JAMA Internal Medicine, looked at the use of scribes among 18 primary care physicians.

To conduct the study, researchers looked at physicians at two medical center facilities within an integrated healthcare system, gathering data between July 1, 2016 and June 30, 2017.

The research team assigned PCPs randomly to two groups, one with and the without scribes, for 3-month periods, switching physicians between the with and without groups every three months. At the end of each three-month period, the PCPs filled out a six-question survey which collected their perceptions of documentation burdens and visit interactions.

In addition to capturing PCP perceptions of scribe use, researchers also collected objective data, including time spent on EHR activity. They also surveyed patients of participating PCPs to gather data on the patients’ perceptions of visit quality.

When all was said and done, the research team found that scribed periods were associated with less self-reported after-hours EHR documentation work.

Researchers also found that when they used scribes, PCPs were more likely to report spending more than 75% of the visit interacting with the patient and less than 25% of the visit on the computer. In addition, physicians were more likely to finish their encounter documentation by the end of the next business day during scribed periods.

What’s more, 62.4% of patients said that scribes had a positive effect on the visits, while just 2.4% said they had a negative effect.

The researchers’ take away from all this was that the use of medical scribes could be one strategy for improving physician workflow and primary care visit quality.

As I noted previously, other research has drawn similar conclusions. For example, a study published in 2015 (which included the involvement of scribe provider ScribeAmerica) found that scribe use at the two hospitals was linked to an improved Case Mix Index which ultimately led to gains of about $12,000 per patient. Meanwhile, inpatient physicians were able to cut time spent the chart updates by about 10 minutes per patient on average.

Having been over arguments for and against scribe use, my personal conclusion is that working with them can be a worthwhile investment if doing so is a good fit for the physicians involved, but doesn’t work in all cases.

Ultimately, it seems that there’s too much variation between settings in which scribes could be used to make a single blanket statement about their benefits. I guess we won’t be drawing grand conclusions about scribe pros and cons anytime soon.