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All Things EMR | Healthcare Policy & Reform

The Week in Government HIT: June 25, 2010

-       Monday, June 14: Dr. David Blumenthal posts an article about “change” on his blog. “Resistance to change” is usually the name we give to unsolvable value problems. Physicians don’t find a compelling business reason to adopt an EMR, or at least not one that is worth the considerable risk. Because of the public benefits of quality data and decision support, we would like physicians to digitize. But since legacy EMRs haven’t fixed the value proposition, they complain that physicians are afraid of change. That’s where athenaClinicals comes in. With a focus on revenue, productivity and relieving the burden of quality reporting, we’ve married the public benefit to the physician’s values.

-       Monday, June 21: CMS  launches the official website for Medicare and Medicaid incentive programs. It’s not particularly elegant, but it’s stuffed with helpful overviews and tools. Information on registration, eligible provider definitions, “meaningful use” and spotlights are all included.

-       Thursday, June 24: ONC releases a temporary certification rule for EMR products. Organizations that choose to become Authorized Certification and Testing Bodies (ACTBs) will pay $75,000 for the privilege. CCHIT will not be grandfathered in, and neither will the products that they certified. A permanent certification rule will be released later this year. See Dr. Blumenthal’s blog post, or this summary from the Drummond Group.

-       Friday, June 25: The House passed a six-month fix to the 21% Medicare cut, retroactive to the June 1. But because the Senate is already sitting on 200+ bills from the House, it remains to be seen when it will be reviewed and passed. Medicare has begun processing payments on bills from June 1 with the 21% payment cut, truly a devastating result for physicians and their patients.  For additional reading, see this New York Times overview and commentary from The Health Care Blog.

All Things EMR | Healthcare Policy & Reform

Plug Into Meaningful Use, Don’t Try to Build It

Jonathan BushI read yesterday in The New York Times (okay, someone read it to me), that hospitals and docs are saying “meaningful use” is just too much, too fast. I have to say, I would sympathize . . . if I didn’t know about the Internet!

If someone told me that the federal government was going to make (or at least ‘encourage’) everyone commute via hot-air balloon by 2011, I’d start to feel edgy right about now. How do you make or buy one? Who sells them?  What if the wind blows the wrong way?

This would be my panic—unless I knew about a little-known hot-air balloon service that DEALS with all of it. Like a taxi service. You tell it where you want to go and when and then boom! a balloon shows up piloted, prepped and ready.

Such a quandary exists in the EMR market today. Everyone thinks the government rules mean that meaningfully using electronic health information actually means meaningfully using information you BUILD YOURSELF! They think you have to buy EMRs and servers and program them to meet government rules and then re-program them to meet rule changes. This would give me hives, even if I were a giant health system. Even systems with big budgets don’t have a comparative advantage in programming software!

The result is that many, many practices are getting out of Dodge. I haven’t seen as many practices for sale since 1995 when the explosions of PhyCor and MedPartners caused practices to sell to hospitals in search of AR support. In a poll we did recently with Sermo, 60% of responding docs said they were considering selling out to bigger entities! Even if the industry is moving toward easier-to-manage options with “hosted” software, many versions need to be upgraded, and the government (and payers, and associations who create protocols of care) all keep changing. It’s too hard to keep up with the complexity, and that’s why physicians are selling their practices.

Similarly, hospitals are now trying to facilitate “health information exchanges” and they’re setting them up and trying to fly them. Whew! If I was in the middle of the air and the New York Times called me, I think I’d also feel like the Charles Grodin character in the movie “Midnight Run.” See below starting at about 0:55.

Okay, this is sounding so shamefully obvious…use a web-based service !

Why? Our web-based service allows us to respond to any changes from Washington. We can patch rules out nightly to all our clients if needed. We have an intelligence team that monitors all proposed changes to meaningful use and works with our EMR developers to make sure we comply. Finally, our back-office services help physicians enroll in the stimulus programs, collect payment, and report on necessary clinical measures. We not only run the balloon service but we run it in the “cloud” (sorry, couldn’t resist)!

Oh, and I am so confident our clients will meet meaningful use with a web-based service that I am guaranteeing their first government incentive check. You can even read the fine print if you want.

In other words, don’t build meaningful use – USE IT!  This is not lost on people because we see a lot of hospitals attempting to build their own information services! The problem is that they are BUYING legacy software and attempting to make it look like a service. Yeesh. (Citrix WinFrame anyone?) Aside from the clunkiness of making legacy software quack like an online network, there is the cost . . . but I’ll save that rant for another day.

Medical Billing & Payers

Are National Payers Edging Past Regionals?

New to this year’s 2010 PayerView results is the debut of a lens that ranks “All Payers” included in the athenahealth PayerView dataset. A total of 137 payers were included, with top performers representing payers from across a variety of groups.

The top 10 ranked payers are: 


2.  Humana


4. United Healthcare

5. Tufts


7. Medicare B-GA

8. Medicare B-NC

9. Medicare B-OR

10. ODS Health Plan

Despite the notion that health care is regional and regional payers should dominate, that may not be so.

athenahealth 2010 PayerView results indicate that national payers are competitive when rated against measures that matter to providers, such as speed of payment and transparency of billing guidelines.  

Based on our experience, it’s believed that standard transactions such as claims, eligibility, and electronic remittance advice have a role in leveling the playing field.  In reviewing the top performers, payers that are able to leverage standard transactions, and complement with a streamlined business process, will generally outperform peers that aren’t able to do so. 

While PayerView results suggest that the ease of working with a national payer is on par with regional payers, it is unclear if local presence and knowledge of the market can change a provider’s perception of that burden. 

Several things come to mind:

- Do you think that standard transactions are playing a role in leveling the playing field?  Have transaction standards given everyone the same playbook, and therefore reduced the need to tailor to local markets?

- Why is it so surprising to see national payers bubble to the top?  Shouldn’t national payers be able to leverage centralized functions while aligning with local market needs?

- Can we still say that health care is local?  What are the implications to those that currently participate in the supply chain?

Send back your comments and we can start a discussion.

Healthcare Policy & Reform

The week in Government HIT: June 4, 2010

- Tuesday, June 1: A 21% cut to Medicare reimbursements narrowly averted. Doesn’t this happen every year?

Wednesday, June 2: As anticipated, CMS announces the Multi-Payer Advanced Primary Care Practice Demonstration project. This three-year patient-centered medical home (PCMH) project will provide increased Medicare payments to primary care practices that demonstrate advanced capabilities.  Would you like to know more? We also had two more PCMH projects kick off in Ohio and Rhode Island. And did you know that BCBS-Michigan has had a PCMH project for 1,200 physicians for more than a year now?

Thursday, June 3: Some $83.9 million in stimulus funds awarded to community health centers across the country. The money pays for new EMRs and HIT innovation projects in these centers. Check out this press release.

Thursday, June 3: Cost and quality transparency are this century’s healthcare policy game changer. Each in their own way, nearly every provision of PPCPA and HITECH are designed to give healthcare consumers more information about their care. This is neither good nor bad – it’s just the new environment. None of this is possible without health care IT, putting athenahealth and others at the center of the transparency movement. What’s the news? AHRQ releases a new tool called MONAHRQ to help publicize quality data. As described in this statement, MONAHRQ allows hospitals to create a customized quality website with self-reported data. Combined with athenahealth co-founder and current CTO at HHS Todd Park’s data democracy movement, 2010 marks the advent of the future of healthcare.

Thursday, June 3: Also on the topic of transparency, CMS is making progress in the implementation of Accountable Care Organizations (ACO). They released this FAQ to help the healthcare community understand more about how they plan to implement them. Scheduled start date: Jan 12, 2012. AMGA put together a set of principles that are worth reading.

Healthcare Policy & Reform

The HITECH Act Meets Its Match!

It’s understandable if you haven’t skipped out on your patients for a few hours to sit down with a cup of coffee and a copy of the HITECH Act to find out what it means for your practice.  Aside from the HITECH Act itself, just the draft requirements for “Meaningful Use” take up more than 700 pages. 

That said, the waves of change and reform coming out of Washington, D.C. these days are very real and are coming way faster than you can keep up with. To save you valuable time and to help convey what the new laws and mandates will mean to the success of your practice and the health of your patients, we’ve produced this five-minute animated video.


This new overview video gives you the general background on the HITECH Act, Meaningful Use, details on the financial benefits available to physician practices, and the role Regional Extension Centers will play.  You can also learn about our HITECH guarantee.

As it is with all our services, we’ve done the heavy-lifting with this easy-to-follow video so you can focus on being a doctor.

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