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EMR Overbilling Investigations Sling Mud At Meaningful Use Program

Posted on October 31, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In the wake of an expose in The New York Times claiming that upcoding and overbilling was increasing with the use of EMRs, and members of Congress riding the claim, I guess ONC had no choice but to take the allegations seriously.  So fearless leader Farzad Mostashari, M.D. has asked the advisory HIT Policy Committee to study whether providers are using EMRs to upcode Medicare bills.

I suppose you can tell from how I put that that I’m far from convinced EMRs are generating massive amounts of illegitimate bills, but the idea is “out there” now and dangerous to the future of HITECH objectives. So I suppose it’s a good thing that ONC is investigating.

Dr. Mostashari wants to find out whether EMRs tend to foster the use of higher billing codes by encouraging doctors to cut and paste information from one patient encounter to another, according to an interview with the Center for Public Integrity. He’s also asking the policy committee to determine whether some EMR functions prompt physicians to overbill.

All of this leaves me sort of uneasy.

Don’t get me wrong, I’m not suggesting that EMRs aren’t generating any upcoding issues at all. We all know that many physicians feel pressured to cut and paste text in an effort to get through their heavy workloads, particularly if they’re not otherwise comfortable with their system.

Also, I can’t deny that there are bad apples in every profession, including medicine, who could conceivably be taking advantage of the newness of the technology to reap a profit.

No, my concerns are more that countless providers will have one more thing to worry about as they use the new technology, and that policymakers will view EMRs with a level of suspicion they hadn’t before.  We’re at a tricky point in the overall EMR adoption curve, and bad vibes and publicity are the last thing we need. Meaningful Use compliance is tough enough as it is.

Healthcare Cloud Spending Slated For Major Growth

Posted on October 30, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Hospitals may still be ambivalent about using the cloud for clinical data transport, but attitudes are likely to undergo a major change over the next few years, according to research firm MarketsandMarkets. The firm projects that the healthcare cloud market will expand by about 20.5 percent per year over the next five years, hitting $5.4 billion by 2017.

Right now, healthcare cloud spending has hit roughly $1.8 billion, which represents penetration of four percent, MarketsandMarkets found.  That’s just a drop in the bucket, particularly given the big competitors who are aiming their guns at the healthcare cloud market today. (Other estimates put healthcare cloud penetration at 16.5 percent of the marketplace, still a small number though meaningfully larger than MarketsandMarkets’ number.)

As our sister site EMRandHIPAA.com previously noted, Verizon’s Enterprise Solutions division is offering five “healthcare-enabled” services, including colocation, managed hosting, enterprise cloud, an “enterprise cloud express edition” and enterprise cloud private edition. Verizon hopes to capture healthcare IT managers who are worried not only about HIPAA-secure clinical data transport, but also HIPAA-appropriate data protection on site, as it’s training hosting workers to be HIPAA-ready.

Another set of deep pocketed healthcare cloud vendors are AT&T and IBM, who are partnering to capture what they deem to be a $14 billion healthcare cloud market.  Under the terms of an agreement announced in early October, IBM will provide data storage facilities and services, while AT&T will provide the network.

What could possibly hold back the advance of such giants?  Well, a number of issues, MarketsandMarkets notes. While vendors large and small may promise to be compliant with healthcare regs, healthcare data is challenging to manage, given that it requires special security, confidentiality, availability to authorized users, traceability of access, reversibility of data and long-term preservation.

My guess is that hospitals will respond to the efforts of vendors to attract cloud business, but that the market for public cloud services in particular won’t shoot upward as MarketsandMarkets predicts, as there’s just too many things that worry CIOs.  How about you, readers?

My Surprise Breakfast with Epic CEO Judy Faulkner

Posted on October 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the highlights of my experience at CHIME 2012 was a surprise breakfast that happened on the final day of CHIME. I actually was a touch late to breakfast after skipping out of a mostly empty room talking about HIPAA (imagine that on the last day of a conference). I got my breakfast and sat down at a table of what turned out to be mostly hospital CIOs.

Meals at CHIME turned out to be a great time to meet, connect and learn from the hospital CIOs that attended. A lively conversation was happening when a lady sat down next to me. I looked up and to my surprise the lady sitting next to me was none other than Judy Faulkner, CEO of Epic. I’m sure she had no idea who I was and I later realized that she likely sat next to me because on the other side of her was a hospital CIO she wanted to apologize to for something that had happened months before.

As an EHR blogger, I admit that I was probably a bit star struck sitting next to Judy. This was probably accentuated by the stigma (right or wrong) that Epic doesn’t like the media very much. So, I decided that rather than probe into Judy like a normal media person (I prefer to be a thought leader as much as I am a journalist anyway), I decided to just sit back and mostly listen.

It made for a really interesting experience since one of the first things Judy talked about was apologizing to this hospital CIO. I’m sure the cynics out there would say that she was probably apologizing because she wanted to further Epic’s business with that CIO. However, that wasn’t the impression I got from Judy. Instead, I got the impression that she had a real feeling of guilt that something she had done had caused other people some amount of trouble. In fact, how troubled she was by something most of us wouldn’t think twice about I think says something about Judy. I think some like to characterize her as a tough, driven, hard-nosed, business woman. Maybe she is in the boardroom, but my experience at breakfast was of her as a very thoughtful caring person.

When I told some of my colleagues about my experience with Judy, she told me I’d been seduced. Maybe she’s right. From my experience I saw a very kind, compassionate Judy.

I’ll wait to share all of the things I learned from my time with Judy for another time, but I did also have an interesting conversation with Judy about Twitter and social media. I think the conversation began because I playfully suggested that she should post whatever we were talking about to Twitter. I say playfully, because I was quite sure I’d never seen Judy on Twitter or any other social media and so I was interested to see her response. She responded something like, “I hope I live my whole life and never go on Twitter.”

While I was partially taken back by the sharpness of her response (Although, thinking back I shouldn’t have been surprised), I replied that “Twitter’s not about ‘what I ate today’ and that there was real value to engaging on Twitter.” To Judy’s credit, she then asked why I thought she should be on Twitter.

My response in the moment was pretty terrible. I told her about Twitter’s ability to “connect people.” While this is valuable to many people, the last thing that Judy wants in her position is more random people connecting with her. After giving such a lackluster response, I decided a broader answer I could have given would be, “Social media is about people and people are the most valuable asset in the world. Social media leverages people in amazingly powerful ways.”

That answer is still not perfect without examples and application, but at least the answer applies more broadly in a way that she could benefit from social media. After this experience, I asked myself if I was doing a keynote on healthcare social media, what would I say?

I’ve already come up with 21 ways to benefit from social media. I’ve also started creating a list of very specific examples of social media in healthcare. If you have more examples, I’d love to hear them in the comments. It only seems fitting that I’d use social media to help me put together this resource, right?

I’m still debating the best way to spread what I gather about healthcare social media, but I think it needs to happen. I still run into far too many people that think that social media is just about what you ate for lunch or your drunken pictures with friends. More people need to be informed about the amazing possibilities with healthcare social media. Plus, next time I happen upon breakfast with Judy Faulkner, I’ll have a much better answer for her.

Hospitals Behind On EMR ROI Measurements

Posted on October 26, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Buying an EMR is one of biggest investments a hospital IT department is likely to make. To date, however, few hospitals are planning for and implementing EMR ROI measures early in the game, according to a new study from Beacon Partners.

Beacon interviewed more than 300 healthcare leaders about the clinical system performance measures they used for their EMR, as well as the resulting ROI.  What researchers found out was that most respondents weren’t happy with their organization’s attempts to measure the ROI on their EMR spend — and that many hospitals aren’t directly measuring ROI at all.

According to healthcare leaders who spoke with Beacon, quality management and IT departments, rather than financial executives,  generally institute EMR performance measures. All told, 40 percent of respondents said that they were using performance measures, but only 36 percent were satisfied with the extent to which the data was being used to measure the value EMRs brought to their organization, Beacon reports.

The problem may spring from a lack of planning. According to Beacon’s respondents, less than half (48 percent) of performance measures are determined during planning.  In fact, 32 percent of providers said that performance measures were implemented in at least one patient care area post-EMR implementation.  Fifty-one percent of respondents said that they would have preferred to implement clinical system performance measures earlier than they had done so.

It’s hard to tell what would deter these healthcare execs —  mostly leaders with community hospitals — from demanding more results from their EMR investment. My best guess, though, is that adhering to Meaningful Use guidelines has taken up all of their bandwidth, and that CFOs have been mollified by the promise of incentive payments from the feds.

As the Beacon study suggests, though, healthcare leaders aren’t satisfied with this state of affairs. Vendors, expect to get more searching questions about ROI measurement over the next year or two.

Massachusetts HIE Kicks Off With Golden Spikes

Posted on October 25, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

If you’re a history buff, you may know of the Golden Spike connecting the eastgoing and westgoing tracks of the First Transcontinental Railroad in 1869. It’s hard to overestimate how important that day was in the history of U.S. industry and transportation, despite the fact that it didn’t actually mark the day a seamless coast-to-coast rail network was completed.

This week, another big link-up was celebrated with ceremonial golden spikes, with some comparably high hopes attached. This one, however, was between disparate EMRs in Massachusetts, writes John Halamka, MD in Life As A Healthcare CIO:

Today we made history in the Commonwealth of Massachusetts.   At 11:35am Governor Deval and his physician sent the Governor’s healthcare record from Massachusetts General Hospital to Baystate Medical Center.   It arrived and was integrated into Baystate’s Cerner medical record.

Lots of other demonstrations followed, pingponging data from hospitals to payers to physicians to the Massachusetts eHealth Collaborative (which measures quality and performs data analytics).

Among the most interesting facts Dr. Halamka noted was the list of varied EMRs that shared data, including Partners Healthcare’s LMR, eClinicalWorks, a custom payer system and self-built analytics applications.

What took place was no less than a revolutionary event, suggested Dr. Halamka:

Within seconds, we broke down silos, demonstrating that care coordination, population health, and quality analytics based on healthcare information exchange is now possible in Massachusetts.  

By the way, for those who haven’t crossed paths with the indefatigable Dr. Halamka, he’s Chief Information Officer of Beth Israel Deaconess Medical Center. So his institution is central to this new effort (of which he’s quite justifiably proud).

My question is just how this trick was pulled off. Did the participants use the CCD format, Direct Project protocols, discrete data or something else?  Regardless of how the data’s being exchanged, it seems to me that the rest of the country should consider following suit.

What differentiates EHR Consulting Companies?

Posted on October 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

While at CHIME 2012, I had the chance to sit down with David Tucker, MBA, MHA, FCHIME, VP of National Sales at ESD and Kelly Mulligan, RN, BA, Chief Operating Officer at ESD. I learned a lot from them about what’s happening with hospital CIOs. Plus, it was great to get some first hand perspective on the EHR industry from a former hospital CIO (David Tucker) and an RN (Kelly Mulligan).

I pulled out a video camera to capture some of the things we talked about. I’ll be posting a number of videos with them over the next few weeks, but I’ll start with their answer to the question: What differentiates EHR consulting companies? They mention the KLAS EHR consulting form ratings and even talk about hospital CIO’s being burned by EHR consulting companies in the past.


What Differentiates EHR Consulting Companies Video

Senators Join Initiative To Scrutinize Meaningful Use

Posted on October 23, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A couple of weeks ago, four House GOP leaders wrote a letter to HHS head Katherine Sebelius demanding that she account for perceived failures in the Meaningful Use program.

The four congressmen had written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

Politics being what it is, the other shoe had to drop, and now a group of senators have offered their own objections.

Sens. John Thune and Dr. Tom Coburn of the Finance Committee, and Richard Burr and Pat Roberts of the Health, Education, Labor and Pensions Committee have formally requested that CMS and ONC staffers meet with the latter committee regarding the final rule for Stage 2 of Meaningul Use.

In a letter to HHS, the senators raise several questions:

* Do EMRs sometimes increase utilization of diagnostic tests, and if so, how should the government respond?

* Have some providers gotten subsidies for EMR systems they had in place prior to the kickoff of  Meaningful Use? If so, what is HHS doing to claw back such payments and prevent future outlays of this kind?

* Has the use of EMRs boosted providers’ billing of Medicare, and thereby raised the cost of the program?

* What is HHS’s strategy for “meaningful interoperability”?

Interestingly, the senators’ letter stops short of demanding a halt on MU payments, which the congressmen did in no uncertain terms.  But they’re clearly antsy about the future of the Meaningful Use program, which has paid out $6.6+ billion in incentives to date.

And you know what?  It’s about time that Congress got interested in the future of EMRs and Meaningful Use specifically.  Better to have them breathing down HHS’ neck now than further down the line when there’s far less opportunity to turn the MU battleship.

Call Me Maybe at #CHIME12

Posted on October 22, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I’ve mentioned, it was my first time attending CHIME and it was exactly what I expected it to be. A great place to connect with Hospital CIOs and the leaders in the healthcare IT space. At the final reception, CHIME put together a video of many of the people involved in CHIME in a great Call Me Maybe video:

Private Payers Don’t Want To Play Meaningful Use Games

Posted on October 19, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 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. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today, health IT writer Neil Versel tweeted an interesting observation:

It is indeed interesting to note that while private payers have encouraged physicians to engage in some forms of electronic communication (notably electronic claims adjudication), they’re not setting up their own mini-Meaningful-Use programs.

Now, they are pushing for business models, such as ACOs and the medical home, which require smart use of EMRs. But to my knowledge, few if any health plans have gotten into a tug of war with with providers as to how they use their EMRs, or offered incentives for using an EMR in any specific way.

There’s clearly a reason for that. So what conclusion can we draw from the lack of Meaningful Use-style demands by payers?

Just this — that payers feel their money is better spent on rewarding positive care outcomes and efficiency.

Pay for performance programs have been in place for quite some time now, and evidence is accumulating that they’re effective. According to the Health Care Incentives Improvement Institute, its Bridges To Excellence-recognized physicians have been found to:

  • Outperform non-recognized physicians on process measures of quality.
  • Have fewer episodes per patient and lower resource use per episode.
  • Have lower average costs per patient and per episode.

Clearly, payers have gotten interested in HIEs; data in the aggregate definitely serves their needs. But when it comes to EMRs, they don’t get as excited. So far, the evidence that EMRs can achieve these kind of quality improvements are scattered at best, though there are some promising signs emerging.

Bottom line, payers don’t seem to care much just how engaged providers are in using EMRs, as long as the provider does enough to make entities like medical homes work. The specifics of how providers use EMRs don’t seem like something they’re worrying about.

I’m not suggesting that Meaningful Use programs are a bad idea — it often takes government to do needful things that the private sector can’t or won’t touch — but the fact that payers aren’t pushing something similar does make you think, doesn’t it?

Attending CHIME 2012 Fall CIO Forum

Posted on October 17, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I arrived at the 2012 Fall CIO Forum for CHIME. I’ve wanted to go to this event for quite a while. My fellow blogger, Neil Versel, had often told me about how great the event was and so I wanted to see it first hand.

Tonight I heard an almost emotional Farzad Mostashari speak and then got to mingle with all of the CIO’s at the evening event. A few things I’ve already noticed that I found interesting.

First, Farzad has really refined his pitch for healthcare IT. He makes a really compelling case for what’s possible and a really common sense analysis of why we need to start using healthcare IT now. If I were to put a title on Farzad’s talk at CHIME, I’d call it, “Stop with the Excuses, We Can Do Better.”

Everything at the event is high class. You can tell that no expense was spared to make sure that the major healthcare IT contributors are treated well.

I wasn’t that surprised, but it’s unfortunate that I was by far the youngest person at the conference (at least from what I saw). One wife of a CIO I talked with asked why there weren’t more young people present. Then she said, “Don’t these hospital CIOs want to groom the next generation of leaders? Why are they holding on so tightly and not preparing for the future.” It’s a good question I wasn’t really sure how to answer.

There are a lot of really powerful people at the event. It was fun to see Judy Faulkner mingling with people. I saw John Glaser. In many ways, it’s a Who’s Who of hospital health IT.

While there are many Hospital CIOs at the event, there are also a lot of vendor representatives. Not surprising considering the amount of budget these hospital CIOs control.

I was amazed at how many people were “old friends.” You could see that many of those attending have been doing so for years and this was their annual visit with colleagues. As a first time attendee, you’d think that I might not feel very welcome, but the opposite was the case. All of the hospital CIOs I met were very friendly, kind and happy to engage.

More on the event tomorrow. If you’re in Palm Springs at the event, I’d love to talk with you. Just leave a comment below or send me a tweet.