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Hospital Execs Underestimate QPP Impact

Posted on July 7, 2017 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 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

A new survey by Nuance Communications suggests that hospital finance leaders aren’t prepared to meet the demands of MACRA’s Merit-Based Incentive Payment System (MIPS), and may not understand the extent to which MIPS could impact their bottom line. Worse, survey results suggest that many of those who were convinced they knew what was involved in meeting program demands were dead wrong.

The survey found that many hospital finance leaders weren’t aware that if they don’t participate in the MIPS Quality Payment Program (QPP), they could see a 4% reduction in Medicare reimbursements by 2019.

Not only that, those who were aware of the program didn’t have a great grasp of the details. More than 75% respondents that claimed to be somewhat or very confident about their understanding of QPP got the 4% at-risk number wrong. Meanwhile, 60% of respondents either underestimated the percent of revenue at risk or simply did not know what the number was.

In addition, a significant number of respondents weren’t aware of key QPP reporting requirements. For example, just 35% of finance respondents that felt confident they understood QPP requirements actually knew that they had to submit 90 day of quality data to participate. Meanwhile, 50% either underestimated or did not know how many days of data they needed to provide.

On a broader level, as Nuance noted, the issue is that hospitals aren’t ready to meet QPP demands even if they do know what’s at stake. Too many aren’t prepared to capture complete clinical documentation, develop business processes to support this data capture and raise provider awareness of these issues. In other words, not only are finance leaders unaware of some key QPP requirements, they may not have the infrastructure to meet them.

This is a big deal. Not only will their organizations lose money if they don’t meet QPP requirements, but they’ll miss out on a 5% positive Medicare payment adjustment if they play by the rules.

Lest the respondents sound careless, let’s do a reality check here. Without a doubt, the transition into the world of MIPS isn’t a simple one. Hospitals and medical practices will have to meet deadlines and present quality data in new ways. That would be a hassle in any event, but it’s particularly difficult given how many other quality data reporting requirements they must meet.

That being said, I’d argue that even if they’ve gotten a slow start, hospitals have enough time to meet the basic requirements of QPP compliance. For example, turning over 90 days of quality data by March of next year shouldn’t be a gigantic stretch in contrast to, say, submitting a year’s worth of data under advanced Meaningful Use models. Not to mention the Pick Your Pace option of only 1 measure which avoids all penalties.

Clearly, having the right health IT tools will be important to this process. (Not surprisingly, Nuance is picking its own reporting tools as part of the mix.) But I’m struck by the notion that organizations can’t live on technology alone in this case. As with many problems in healthcare, tech solutions aren’t worth much if the business doesn’t have the right processes in place. Let’s see if finance executives know at least that much.

ACOs Not Scaling Well, But Health IT Helps

Posted on March 13, 2017 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 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

ACOs were billed as the next big thing in healthcare, a model which would create economies of scale and tame rising costs of care. In theory, unifying hospitals and doctors into an overarching entity – and creating shared clinical and financial goals – should improve care and boost efficiency.

Of course, creating them doesn’t come cheap. In fact, creating even a modest ACO typically calls for between $1 million and $3 million in capital investment, according to Michael Deegan, MD, who recently developed a course on ACOs for the University of Texas at Dallas. It also takes 18 to 24 months to launch an ACO, Deegan told an interviewer at UT.

But once all of the Ts have been crossed and the Is dotted, ACOs can meet their stated goals, right? Actually, not so much, though health IT can help things along, according to Indranil Bardham, a colleague of Deegan’s at UT Dallas who serves as professor of information systems.

According to an article in HealthcareITNews, Bardhan recently completed a study on ACO performance which concluded that health IT had a measurable impact on their efficiency. The study, which drew on 2013-2015 data from CMS, reviewed the performance of 400 ACOs.

Among the key takeways Bardhan took from his research was that the larger an ACO was, the more likely it was to be inefficient. This flies in the face of conventional wisdom, which would suggest that bigger is better when it comes to improving efficiency.

On the other hand, health IT use had the effect its champions might hope for, though modest in scope. The study concluded that a 1 percent increase in HIT usage was associated with an 0.5 percent increase in ACO efficiency.

The thing is, these measures represent just a couple of ways to evaluate ACO performance, making it hard to tell just what is working, Bardhan told HIN. “Healthcare, with respect to ACOs, is fascinating because there is not just one single output measure that you are using to compare performance,” he told the magazine’s Bill Siwicki. “…It is difficult to measure the performance of organizations against each other when you have multiple outputs that cannot easily be transformed into a single dollar number.”

This squares with commentary by other ACO researchers, who seem to agree that the whole ACO evaluation process is a bit mysterious. As health policy analyst David Introcaso notes, in a review of ACO-based Medicare Shared Savings Program, CMS isn’t helping either. “While CMS details financial and quality performance results, the agency does not explain, at least publicly, how results, favorable or unfavorable, were achieved.”

Without knowing more about what we should measure, and why – much less what steps helped in achieving their results – it’s too soon to tell what type of health IT should be deployed in ACOs. But looked at more optimistically, once we have a better idea of what ACO success factors are, it seems likely that health IT tools will help execs address them. (For a look at one completely health IT-based ACO concept, see this piece on the Virtual ACO.)

Meaningful Use Has Done Its Job

Posted on September 19, 2016 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 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

While Meaningful Use has been challenging at times, the vast majority of hospitals seem to have stayed on top of things. In its new report on the IPPS negative payment adjustments for fiscal 2017, CMS said that 98% of eligible hospitals and critical access hospitals managed to avoid Medicare payment dialbacks for next year, because they successfully attested to stage 1 or stage 2 Meaningful Use compliance, according to EHR Intelligence.

CMS began making Medicare payment adjustments on October 1, 2014 for eligible hospitals, of which there are more than 4,800 in the United States. The current adjustment will fall into place on October 1, 2016, as a reduction in the percentage increase to the Inpatient Perspective Payment System.

The negative payment adjustments to the IPPS now stand at 75%, up from 25% for the 2013 reporting period. Eligible hospitals had a chance to apply for hardship exceptions to the payment adjustments, though if they haven’t done so already it’s too late, as the window for seeking those exceptions for 2017 closed in April of this year. But as noted, few hospitals will be affected.

At this point, it’s worth taking time to stop and admire how this took place. Even when you consider that the feds handed lot a lot of money in incentives, this has all happened relatively quickly as IT investments go. Everyone likes to talk about how successful the banking industry was at rolling out interoperability with ATMs, but I doubt the backroom negotiations went any faster than the cascade of Meaningful Use attestations. In other words, Meaningful Use did its job.

After all, very few programs achieve close to 100% compliance under any circumstances. Even if providers face large government fines, no initiative is going to get 100% of the industry on board. So bringing 98% of eligible hospitals on board within a few scant years is an impressive achievement, particularly considering the healthcare industry’s record of foot dragging when it comes to new technologies.

Of course, the industry has clearly gone well beyond the need for Meaningful Use’s rather mechanical reporting requirements, valuable though they may have been as a training ground. So if we assume that Meaningful Use isn’t that, well, meaningful anymore, what’s next?

The answer is….drumroll…quality. Most hospitals will be focusing on the larger and more complex quality measurement demands imposed by the next generation of incentive payments proposed by CMS.

As many readers know, the Medicare Meaningful Use program for ambulatory is being rolled into the Merit-Based Incentive Payment System (MIPS), along with the Physician Quality Reporting System and Value-Based Modifier programs. beginning with the 2017 performance year.

Meaningful Use now has a new name in ambulatory care, Advancing Care Information, and strong performance on this measure can contribute up to 25% of the MIPS score a provider receives – or in other words, smart health IT deployment still counts. But that’s dwarfed by the 50% of the score contributed by strong quality performance.

This shift away from IT-specific performance measures is necessary and valuable. But as federal authorities lay out their new incentive programs, it’s worth giving good ol’ Meaningful Use a send-off. A job needed to be done, and however unsubtly, MU did it. We’ll see how quickly the MIPS program rolls over to replace MU in hospitals.

Hospitals Struggle To Use EHRs To Report eCQMs

Posted on July 18, 2016 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 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

A new study by CMS has found that hospitals are struggling to use their EHRs to report electronic clinical quality measures. The agency found that while EHRs helped contractors collect data remotely using hospital staffers, EHR platforms “had not yet matured” enough to meet the specs required, according to Managed Care magazine.

The CMS findings came from a validation pilot study of eCQMs. The goal of the pilot study was to evaluate approaches for validating eCQMs for the Hospital Inpatient Quality Reporting program.

The program, which was mandated by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, authorized CMS to pay hospitals a higher annual update to their payment rates if they successfully reported designated quality measures. Later legislation mandated that Medicare hospitals that don’t successfully report would be hit with a 2.0% reduction in the annual rate of inflation used to calculate payment.

One might guess that putting EHRs in place would help hospitals comply. But it appears that this is not been the case in many instances. In fact, hospital IT leaders are facing some significant challenges in linking EHR data to the required reporting format.

To accurately report eCQMs, hospitals must create complete and accurate Quality Reporting Data Architecture (QRDA)-I files based on 2014 eCQM specifications. But hospitals reported that they were having a hard time mapping the information in the EHR systems to the QRDA-I specifications, particularly given the use of unstructured data fields and multiple source of information for various events, Managed Care reported. Measures match rates, in turn, were rather low, ranging from 12% to 49%.

The hospitals involved in the pilot also said that data mapping and workflow issues were major problems. For example, as it turned out much of the information they needed was locked up in free text, notes or scanned documents rather than discrete data fields. That made it impossible for those hospitals to extract the data and mapping to the elements found in the QRDA-I files.

To solve these problems, pilot hospital reported, CMS should consider addressing three key areas: boost communication, outreach and education to raise hospital and vendor understanding of eCQMs; cut down the burden imposed by eCQM adoption; and offer tools and guidance to help hospitals with eCQM implementation.

As CMS learns, the help hospitals want should be forthcoming. In the report, CMS said that it plans to conduct additional validation pilots in the future. The agency said its goal will be able to help hospitals and vendors transition to eCQM reporting, and over time to increase the accuracy of the data that gets reported.

A Primer on Medicaid/CHIP Managed Care Reform

Posted on May 27, 2016 I Written By

The following is a guest blog post by Megan Renfrew, Director in the Cognosante Solutions Lab.
Megan Renfrew - Cognosante
On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final regulation in the Federal Register concerning managed care in Medicaid and the Children’s Health Insurance Program (CHIP).  The first overhaul of Medicaid and CHIP managed care regulations in more than a decade, the rule “updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans,” wrote CMS Acting Administrator Andy Slavitt and Vikki Wachino, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services, in a CMS blog post.

Approximately 72 percent of Medicaid enrollees in 39 states and the District of Columbia are served through managed care plans, up 14 percent since 2013.  Combined Federal and state spending on Medicaid managed care exceeds $150 billion annually.  Those figures will grow steadily as states continue to expand Medicaid managed care coverage to include larger geographic areas, additional populations, and services previously covered through fee-for-service Medicaid, such as inpatient and Long-Term Services and Support (LTSS).

While the medical loss ratio and other financial requirements received the lion’s share of attention throughout the rule-making process, the rule’s focus on improving the beneficiary experience and increased reporting and data requirements are equally important.  Beneficiaries will benefit from quality improvement requirements, stricter provider access requirements, and stronger care management programs.  Plans and states will need to adjust contracts and IT systems to meet new data, reporting, and analytics requirements that support CMS’s goals of increased program integrity and transparency.

Beneficiary Experience & Protections

To strengthen the experience of beneficiaries, the rule requires states to address disparities and individuals who need long term care or have special health needs in their quality plans for the Medicaid managed care rule.  The final rule, which will be phased in over several years, also creates the first quality rating system for Medicaid managed care plans, aligning Medicaid with Medicare Advantage and Qualified Health Plans rules.  This will allow beneficiaries to better compare plans before enrollment.

On the care management front, the rule includes standards for care coordination, health assessments for new plan enrollees, and treatment plans for enrollees with special healthcare needs or who receive LTSS.  These rules are designed to make sure that beneficiaries receive appropriate care in the appropriate setting, and are assisted in navigating the complex healthcare system.

The rule helps ensure that beneficiaries have sufficient access to providers by strengthening provider network adequacy requirements.  States must add time and distance standards to their state network adequacy rule (31 states already have time and distance standards in place for primary care providers).  Under the final rule, however, CMS spells out the provider types subject to network adequacy requirements in greater detail.  As a result, states must now create standards for more than seven different provider types.  Plans must also report provider network data at least annually, and maintain an up-to-date provider directory for plan members.

Additional changes focus on targeted beneficiary education and outreach.  States must implement systems that support beneficiaries prior to and after enrollment, a role that will likely be played by enrollment brokers.  Under these systems, beneficiaries are educated about managed care, including benefits covered and choice of plans, and their rights and responsibilities under Medicaid.  The beneficiary support system also provides a venue for current managed care enrollees, including assistance navigating the grievance and appeals process.

Enhanced Data and Systems Needs

Under the final rule, states and plans are required to meet stronger data submission and reporting requirements to support program oversight, program integrity, and increased transparency.  To meet these requirements, states and plans must have adequate IT systems to ensure accurate and timely data delivery and reporting.  Some states and managed care plans will likely need to increase their data collection and analytics capabilities to comply with the new rule.

The most important change is that federal payment for Medicaid managed care is tied to the submission of accurate, complete, and timely encounter data to CMS in a CMS-specified format, likely TMSIS.  Historically, some states have struggled to collect complete and accurate encounter data from managed care plans, and to manage that data in legacy systems designed for fee-for-service claims.  Both states and plans will need to examine their current IT systems, data collection and submission processes, and contract language to ensure that they are well positioned to meet these requirements.

In addition to the encounter data requirements, CMS is requiring that states post information on their Medicaid managed care plans on a public website, including enrollee handbooks, provider directories, and plan contracts.  Also required is information about plan performance, including finances, operational performance, quality indicators, measures of customer satisfaction, and the results of program integrity audits.

To meet the stricter provider network adequacy requirements, plans will need to have, at a minimum, accurate data on their provider network.  As states revise their network adequacy rules to meet the CMS requirements and monitor their plans for compliance, they may benefit from using GIS-based tools that automate network adequacy analysis and allow for easy evaluation of policy options and plan performance.

To support program integrity goals, the CMS rule requires all providers in Medicaid managed care plan networks to enroll with the state Medicaid agency.  Enrollment in Medicaid was previously required only of those providers participating in the Medicaid fee-for-service program.  States may find that they need more automated provider enrollment and verification systems to handle the increased workload that this requirement will generate for state Medicaid agencies.  Luckily, provider enrollment solutions are available in the market.

To help ease the burden of implementing the systems necessary to manage the robust data collection, analysis, exchange, and reporting necessary under Medicaid managed care reform, states can leverage CMS’s previously issued final rule extending 90 percent federal matching funds for Medicaid enterprise system development.  In addition to ensuring the permanent availability of this funding, that rule extends its use to commercial-off-the-shelf and software-as-a-service solutions.  This allows states to take advantage of previously developed and tested products in the marketplace.

21st Century Medicaid

CMS and its stakeholders devoted thousands of hours to crafting sweeping reform that brings Medicaid manage care into the 21st Century, including supporting data-driven decision-making and oversight, and allowing for state innovation in delivery system and payment reform. Doing so solidifies Medicaid’s place as a key driver of health innovation and plans’ roles supporting and implementing that innovation.

About Megan Renfrew
Megan Renfrew is a Director in the Cognosante Solutions Lab.  An accomplished health policy expert who spent more than five years drafting healthcare bills for the U.S. House of Representatives, she previously served as the technical director at CMS responsible for collecting and analyzing Medicaid and CHIP eligibility and enrollment data from states. 

Andy Slavitt Talks Healthcare Interoperability and Data Blocking

Posted on February 8, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In all the reporting around meaningful use being replaced (or as many mis-reported meaningful use ending), Andy Slavitt also made a number of other points in his talk at JP Morgan’s Healthcare conference. Much like he did with meaningful use, he live tweeted his talk. Here were a couple of his non-meaningful use tweets that stood out to me.

Has there ever been any doubt that HHS was serious about wanting organizations to be interoperable and for data blocking not to exist? There hasn’t for me. It’s been one of their main goals. The problem is two fold. First, CMS is fighting an uphill battle against the economic realities that not sharing data has been very profitable for healthcare organizations. Second, CMS only has so much power available to them to make interoperability a requirement.

Despite these challenges, CMS is doing everything in their power to encourage and promote interoperability. Put another way, they’re trying everything they can to make it so that interoperability is a wise business decision for healthcare organizations. Although, much of what they’re trying to do also harkens back to a statement I heard from Jonathan Bush, CEO of athenahealth that, “Interoperability should not be used as a point of competition.”

The problem is that today interoperability is used as a point of competition. We’re seeing that change, but it’s slow and there are still many who haven’t made the change. Plus, all of the interoperability solutions that have been offered (yes, I’m looking at the popular FHIR standard) are still quite limited in scope. They’re really just evolutions on existing interoperability and not a revolution to what interoperability should and could become.

Plus, I fear that many of these new interoperability options are really just creating a new market for vendors to charge providers. When you think about it, what’s the easiest way to block the sharing of information? Just charge too much for it. More on this in a future article.

Ironically, I think my perspective on Andy Slavitt’s comments on interoperability and information blocking are not all that different from my view on meaningful use. Andy and the people at CMS are saying the right things. They’re seeing the right dynamics at play in the market place. The problem is that they’re hands are tied in many ways and the bureaucratic process could lead to something even worse if they’re not careful. No doubt they’re dealing with really challenging, complex issues. It’s good to know that their hearts are in the right place. I just hope that regulation and legislation matches it.

EMR Vendors Slow To Integrate Telemedicine Options

Posted on August 27, 2015 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 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

Despite the massive growth in demand for virtual medical services, major EMR vendors are still proving slow to support such options, seemingly ceding the market to more agile telemedicine startups.

Independent telemedicine vendors targeting consumers are growing like weeds. Players like Doctor on Demand, NowClinic, American Well and HealthTap are becoming household names, touted not only in healthcare blogs but on morning TV talk shows. These services, which typically hire physicians as consultants, offer little continuity of care but provide a level of easy access unheard of in other settings.

Part of what’s fueling this growth is that health insurers are finally starting to pay for virtual medical visits. For example, Medicare and nearly every state Medicaid plan also cover at least some telemedicine services. Meanwhile, 29 states require that private payers cover telehealth the same as in-person services.

Hospitals and health systems are also getting on board the telemedicine train. For example, Stanford Healthcare recently rolled out a mobile health app, connected to Apple HealthKit and its Epic EMR, which allows patients to participate in virtual medical appointments through its ClickWell Care clinic. Given how popular virtual doctor visits have become, I’m betting that most next-gen apps created by large providers will offer this option.

EMR vendors, for their part, are adding telemedicine support to their platforms, but they’re not doing much to publicize it. Take Epic, whose EpicCare Ambulatory EMR can be hooked up to a telemedicine module. The EpicCare page on its site mentions that telemedicine functionality is available, but certainly does little to convince buyers to select it. In fact, Epic has offered such options for years, but I never knew that, and lately I spend more time tracking telemedicine than I do any other HIT trend.

As I noted in my latest broadcast on Periscope (follow @ziegerhealth), EMR vendors are arguably the best-positioned tech vendors to offer telemedicine services. After all, EMRs are already integrated into a hospital or clinic’s infrastructure and workflow. And this would make storage and clinical classification of the consults easier, making the content of the videos more valuable. (Admittedly, developing a classification scheme — much less standards — probably isn’t trivial, but that’s a subject for another article.)

What’s more, rather than relying on the rudimentary information supplied by patient self-reports, clinicians could rely on full-bodied medical data stored in that EMR. I could even see next-gen video visit technology which exposes medical data to patients and allows patients to discuss it live with doctors.

But that’s not how things are evolving. Instead, it seems that providers are largely outsourcing telemedicine services, a respectable but far less robust way to get things done. I don’t know if this will end up being the default way they deliver virtual visits, but unless EMR vendors step up, they’ll certainly have to work harder to get a toehold in this market.

I don’t know why so few EMR companies are rolling out their own virtual visit options. To me, it seems like a no-brainer, particularly for smaller ambulatory vendors which still need to differentiate themselves. But if I were an investor in a lagging EMR venture, you can bet your bottom dollar I’d want to know the answer.

ICD-10: We’re (Almost) Ready to Celebrate this Milestone

Posted on August 26, 2015 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

I haven’t written anything about ICD-10 yet and it’s probably because I’m still cautiously optimistic about the October 1, 2015 implementation date; with more emphasis on the cautious part. Anyone who knows me knows I am naturally an optimist, but I just don’t know if I can trust 100% that ICD-10 will go ahead this time without a hitch. The introduction of the proposed Coding Flexibility in Healthcare Act calls for acceptance of both ICD-9 and ICD-10 codes for 180 days after go-live. I think this would create a huge mess with system limitations and inconsistencies. The AMA and CMS have offered a “grace period” for ICD-10 claim denials and PQRS for 12 months which sounds like an acceptable compromise for physicians but I don’t agree with this plan either. We need to move forward with ICD-10 in its entirety as we are long overdue for this implementation.

Healthcare organizations have been steadily preparing for ICD-10 for over 5 years and each time, HIM coders and organizations are disappointed with the repeated delays in implementation. I don’t think most physicians have been disappointed by the delays as they have been vocal in their opposition over the years. I think most healthcare professionals would agree that we need ICD-10 since ICD-9 is outdated and becoming obsolete and we are one of the only countries still not using this classification system.

With the US Congress involved, the entire subject of ICD-10 has been skewed in many different directions over the years. ICD-10 has been inserted into conversations where it doesn’t belong which has resulted in unnecessary delays and excuses. HIM professionals from all over the US have been reaching out to US Congress men and women in efforts to educate these elected officials on the benefits of implementing ICD-10. This go-round, we are closer than ever but there is still a lot of opposing or anxious chatter out there.

At my organization, our coders are trained in ICD-10 CM and PCS. We have dual coded countless records and tested claims to prepare for the change. We feel our hospital is ready (and has been ready) for ICD-10. Our physicians are buzzing about the new code set and they are participating in training over the next few weeks. Our physician office staff are learning what they need to know for physician billing and are providing assistance in the training. Our business office has conducted payer testing and we have tweaked our systems to ensure claims and reports are ready to receive ICD-10 codes. We want to be as proactive as possible in anticipating any decreases in revenue flow.

I know many of my peers feel ready for Oct. 1 and are also waiting for that day to get here before officially celebrating this milestone. We have scheduled an ICD-10 Kickoff party for the morning of Oct. 1 at our organization. Hopefully, this will be a celebration of the implementation and all of our hard work preparing over the years. We must all continue preparing for ICD-10 and remain as optimistic as possible for this long awaited opportunity to improve coding specificity and quality healthcare documentation.

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

ICD-10 – Is Your Hospital Ready?

Posted on July 22, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There’s been some interesting ICD-10 news coming out lately. It make sense since we’re just over 2 months from the October 1st implementation date. I recently made the case that there will be no more ICD-10 implementation delay now that AMA and CMS have joined together. I think that’s the best assurance we can get that ICD-10 will go forward with no more delay. Although, I’m sure that many hospitals will still play Russian roulette and hope for another delay. I think that’s a dangerous strategy.

For those people that still think ICD-10 is a joke (and there are plenty of funny codes), Jennifer Della’Zanna did a good job looking at the “funny ICD-10 codes” and providing some perspective. My biggest takeaway from her analysis is that there have been funny ICD-9 codes and we didn’t make a big deal out of it. Why are we making a big deal out of the rarely used “funny” codes in ICD-10?

Leave it to Brad Justus to put the funny ICD-10 codes in perspective with a little humor:

What are you doing to get prepared? Have you checked with your software vendors? Do you know that they’re really ready or just gotten lip service? Not all ICD-10 implementations are created equal. Will your payers be ready? Do you have an ICD-10 claim monitoring service so you can know which payers aren’t ready on go live date? How’s your ICD-10 training going for your doctors, billers, etc?

I believe that ICD-10 is on its way. Is your hospital ready? Sadly, I think many hospitals won’t wake up to ICD-10 until October 1st. It’s not going to be pretty at those organizations.

Even Without Meaningful Use Dollars, EMRs Still Selling

Posted on June 10, 2015 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 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

I don’t know about you, readers, but I found the following data to be rather surprising. According to a couple of new market research reports summarized by Healthcare IT News, U.S. providers continue to be eager EMR buyers, despite the decreasing flow of Meaningful Use incentive dollars.

On the surface, it looks like the U.S. EMR market is pretty saturated. In fact, a recent CMS survey found that more than 80% of U.S. doctors have used EMRs, spurred almost entirely by the carrot of incentive payments and coming penalties. CMS had made $30 billion in MU incentive payments as of March 2015. (Whether they truly got what they paid for is another story.)

But according to Kalorama Information, there’s still enough business to support more than 400 vendors. Though the research house expects to see vendor M&A shrink the list, analysts contend that there’s still room for new entrants in the EMR space. (Though they rightfully note that smaller vendors may not have the capital to clear the hurdles to certification, which could be a growth-killer.)

Kalorama found that EMR sales grew 10% between 2012 and 2014, driven by medical groups doing system upgrades and hospitals and physician groups buying new systems, and predicts that the U.S. EMR market will climb to $35.2 billion by 2019. Hospital EMR upgrades should move more quickly than physician practice EMR upgrades, Kalorama suggests.

Another research report suggests that the reason providers are still buying EMRs may be a preference for a different technical model. Eighty-three percent of 5,700 small and solo-practitioner medical practices reported that they are fond of cloud-based EMRs, according to Black Book Rankings.

In fact, practices seem to have fallen in love with Web-based EMRs, with 81% of practices telling Black Book that they were happy with implementation, updates, usability and ability to customize their system, according to the Q2 2015 survey. Only 13% of doctor felt their EMRs met or exceeded expectations in 2012, when cloud-based EMRs were less common.

Now, neither research firm seems to have spelled out how practices and hospitals are going to pay for all of this next-generation EMR hotness, so we might look back at the current wave of investment as the time providers got in over their head again. Even a well-capitalized, profitable health system can be brought to its knees by the cost of a major EMR upgrade, after all.

But particularly if you’re a hospital EMR vendor, it looks like news from the demand front is better than you might have expected.