The first of our clients just got issued his Meaningful Use check. He is Dr. Allen Ferguson, a family practice doc in Eaton, Ohio. He practices in a health professional shortage area so it was a little bigger than the $18K maximum year one payment. He was thrilled and we are thrilled for him…but not ecstatic, yet.

Unlike other companies, our goal is not and was never to build an application that could only be used to get a bonus like the Meaningful Use bonus. It is to actually GET EVERY BONUS available and every payment dollar deserved by every doc on our network.  Our mantra for each service team is this: Be the best in the world at getting docs paid for doing the right thing.

This presents a two-fold challenge in this mini-era of Meaningful Use bonus infatuation. First, we want it all, and less than all will not do.  We have guaranteed that every Medicare eligible doc on our athenaClinicals EHR service who signs up and does his or her part will in fact get it. Hence, our real measure of success is 100% of docs winning and NOT the idea that winning is possible. Second, we are committed to ensuring that every doc actually achieves the measures even though the government has taken a “don’t ask/tell” stance by requiring only that docs “attest” that they are compliant rather than show it. We can’t play that way. Since we’re on this thing called the cloud, we actually do know exactly how Meaningful Use compliant every one of our docs is and exactly what they have to do to cross the threshold to meet the definition. In fact, what the hey, here’s a quick snapshot of how our clients were doing as of mid-May on one of our measures:

Cool that we know this right? As it shows, we’re making progress on one of the more challenging measures for providers…but it also shows we’ve got work ahead to get them to the finish line. And the finish line for us is not when every doc is on a certified EHR but when every doc who signed up for our guarantee and did his or her part has banked their payment. That’s when we’ll send out our rooster dance press release.

In the meantime, nice job Dr. Ferguson.

• On May 25, we launched PayerView, our annual analysis of performance in the medical claims billing industry. This blogpost explains the particulars but the big news is that Aetna ranked #1 this year among major payers. To learn more about the complex dynamics of the payer-provider relationship and how PayerView is helping to improve it, attend our free webinar on June 15. Register here.
• Next up, so you’re being peacefully sedated for gall bladder surgery, you start counting down from 100 and the next thing you know, you’re in the recovery room begging the nurse for water but she will only give you a wet towel. Unbeknownst to you, a few hours ago in the OR there was a battle royal between the surgeon and one of the nurses that had to be broken up and everyone had to take a deep breath before they stitched you back up. Don’t believe it? According to the doctors and nurses themselves, bad behavior is fairly common in the health care workplace. The gall bladder scenario might be a bit extreme but the findings are based on a survey of providers who admit a relatively high incidence of what the rest of us would consider “unprofessional” actions. What’s your experience been?
• If you didn’t already get it, health IT is a big bucks industry. According to this report, spending on Health IT will top $40 billion by the end of this year. What’s behind the outlays? The study by market research outfit RNCOS points to health care reform, ICD-10, and federal incentives to adopt EHRs. There is also “Medicaid enrollment, which is expected to increase by 16 million people by 2019.”
• Big bucks indeed. According to the Center for Public Integrity, several groups of providers that were deemed unworthy of federal incentive dollars for meaningful use of EHR want a piece of the action. The well-regarded investigative group is reporting that there’s a lobbying effort underway to include some of the medical provider types that were excluded from eligibility. Here’s how it breaks down: “Physicians, chiropractors, dentists, optometrists, podiatrists, psychiatrists and most hospitals were made eligible to receive the incentive payments. But nurses, physician’s assistants, behavioral health providers, home-care practitioners, emergency medical services, long-term care providers, post-acute providers, federally qualified health centers, rural health centers, rehabilitation hospitals and cancer centers were excluded from participation in parts or all of the program.” What do you think? Even if lawmakers are looking for ways not to spend money these days, is it fair to be so selective about eligibility?
• Due to our association with Dr. Atul Gawande, who recently spoke at our 2011 User Conference, a visitor to athenahealth’s Watertown offices might notice copies of his bestseller “The Checklist Manifesto” on desks and bookshelves throughout. So it was hard not to notice this article from NPR on how the use of simple lists are thought to allow pediatricians, internists and family doctors to provide better care. As you’ll see, the goal is to simplify the processes of care, which is hard to argue against.

The athenahealth 2011 PayerView rankings are finally in! Before we dig into the findings, here’s a bit of background on PayerView and how it works.

This year’s PayerView results come from the actual medical claims billing experience of our 27,000+ providers. That means 47 million charge lines and $9 billion dollars in charges submitted throughout the 2010 calendar year. Services were billed from 41 states to 132 payers that met key criteria like claim volume threshold and client concentration. To get more detail on how PayerView works, what metrics we’ve measured, and to probe the rankings in depth, click here.

OK, the rankings. The 2011 PayerView results reveal some very interesting trends that came to light with the addition of HIPAA transaction metrics like electronic remittance advice (ERA) and eligibility. Medicaids, no surprise, clung to their position as the worst performing payer group. They dominated the lower rungs of the PayerView rankings with Medi-Cal CA coming in dead last out of 132 payers. Unlike past years, national payers secured 3 of the top 5 spots, displacing the regional payers that used to dominate. The top performing payers out of 132 total payers were…drum roll please…

1.            BCBS-RI

2.            Aetna

3.            Humana

4.            UnitedHealthcare

5.            BCBS-MA

And the lowest performing payers were…

128.        Medicaid-TX

129.        Medicaid-PA

130.        Horizon NJ Health

131.        Medicaid-OK

132.        Medi-Cal CA

Aetna stands out of this pack. They made significant inroads and managed to supplant Humana as the best ranked national payer. While Humana actually outperformed Aetna with respect to speed of payment (days in accounts receivable) and a reliable eligibility transaction (Eligibility Accuracy), Aetna’s consistent performance propelled it to the #1 position across multiple PayerView segments such as Major Payers, National Commercial, Midwest Region, etc.

Data suggests, and Aetna performance seems to confirm, that leveraging the full transaction standard suite (e.g. claims, eligibility, ERA, etc.) does translate into gains in performance.  If this is true, what does that say about changes like new clinical quality management programs and new shared savings models like Accountable Care Organizations (ACOs)?

A few questions come to mind:

• How can we take the lessons learned from the transaction standard set implemented in 2003 and apply it on the clinical front? Keep in mind that we are nearing the 10-year mark since the transaction standards were implemented but we still have a ways to go. athenahealth data suggests that although standards have helped the industry gain a common language, disparities remain. By downloading a copy of our whitepaper you can review our analysis of the ERA Transparency metric to get a sense of how all transactions have not matured equally.
• What else will we need to do to complement the standard language that the industry is trying to facilitate through incentives for EHRs and performance-based reimbursement? athenahealth data suggests that the standards will only get you so far, and in the clinical space, the standards have a long way to go before reaching true “standard” status.

What are your thoughts? Send in a comment or a question. And while you’re thinking about it, see what CEO Jonathan Bush has to say…

• Imminent incentive payments for Meaningful Use of EHRs take top billing this week. Health Data Management is reporting that the first checks will be cut any day now, putting up to $18,000 in the bank accounts of many “eligible professionals” around the nation. This is exciting news for us because athenahealth has guaranteed – and worked very hard to back it up –  not just that our doctors will achieve Meaningful Use of EHRs but that they get the incentive money they deserve. We have a client in rural Ohio poised to get his check. In addition to running a busy practice, he works in several local nursing homes and the county jail. He attested in April and he tells us he’s planning to buy some much-needed new laptops for his practice when he gets his check. Stay tuned for news on that soon, we hope! In the meantime, if you are doctor who expects to get a check soon, how do you plan to use the money?
• After serving his two years as ONC, Dr. David Blumenthal is back at Harvard. In this interview he talks about the likelihood and timing of a nationwide health information network, the need for innovation in health IT and of course, Meaningful Use of EHRs. He’s quoted in the article saying “U.S. EHR adoption is a ‘solvable problem’,” and noted that new doctors and nurses coming into the health care workforce are well-schooled in EHR use. Likewise, “with more than 36,000 physicians having applied for meaningful use money so far, and 10,000 more doing so each month, the former HIT coordinator predicted that EHR saturation will come to the health care system.”
• That may be the case—and we hope it’s true—but the HHS inspector general has just released a report urging greater security for EHRs against hackers, fraudsters and identity thieves. Washington Post coverage makes the point that ONC has had to balance encouragement of EHR adoption with security concerns. We are all over the issue. Back in March, our general counsel wrote a blog post about the importance of protecting information in the cloud. Look for more blogposts here about how we protect information in the cloud.
• In more news from HHS, the agency issued a regulation on May 19 to “bring transparency [and] lower costs to consumers by requiring review of large insurance rate hikes.” After Sept. 1, any “proposed increase of 10% for most individual and small group health insurance plans” gets an independent review. And check out related stories on insurance rate increases from HuffPo and Businessweek.
• Nothing gets the attention of the public like a catastrophe, such as, well, a zombie attack. In a social media play that whizzed around twitter and various blogs this week, the CDC released guidance on protecting your home in the event of a ‘zombie apocalypse.’ The larger point is about disaster preparedness for events like hurricanes and using zombies was a clever way to get some attention and make sure you have a  “utility knife, duct tape, battery powered radio” handy. Maybe the undead can be used to push wider EHR adoption?

A week ago here in Boston, we wrapped up a very successful three-day conference for our clients. Check out this earlier account of the event where about 545 athenahealth users met with, learned from, and gave feedback to hundreds of us athenistas. We were particularly proud to have Dr. Atul Gawande make the keynote speech. (You may remember some of my earlier posts about trying to be as sexy as Atul and then having lunch with him.) But I have to say I have always been of two minds about having user conferences.

In speeches when I explain cloud-based EMR and practice management services, I always describe user conferences as prehistoric rituals where the members of that ancient tribe–the software user–would gather, build fires, and pound their chests while making grunting sounds trying to describe new features that they wanted their software vendor to build. The resultant “modules” would be attached over the years, like primordial fins-in-the-making, in exchange for upgrades and consulting fees.

But one of the benefits of being in the cloud means service providers like athenahealth can watch their users in motion, and our designers and developers can witness the frustration of ineffectual code in real time and fix it almost as quickly. Seeing customers struggle, and seeing what they are trying to accomplish and how they go about it, is a VASTLY more effective way to fix problems and to innovate than to try to get a doctor to describe how software should work.

So if we can see our client practices perform in real time, why did athenahealth just host a user conference?

Well, of course, it’s because we want our clients to learn, improve performance, and push their practices to new levels. And we want them to connect with, and learn from, each other in ways they can’t yet do online. But, for me at least, our User Conference is all about the hugs.

We are deeply involved in the lives of our clients. Our account managers go through heaven and hell with their clients…and never lay eyes on them. And so, aside from the CME courses, the table in the hotel lobby set up for “cross-sell,” and the case study interviews, the user conference we just held in Boston was our chance to connect. It was the time we get to meet the person behind the voice and even to learn, for example, that the practice manager and the physician owner we’ve been interacting with all this time….are actually married! Or we learn that a client wants to move the practice into a Victorian house…or start a bicycling group to take on the obesity of their patient populations…

We hugged. I got and gave hundreds of hugs in three days…and I left feeling massively more of what I feel every day in this job–like a man on a mission.