It’s no news to anyone that the EHR market is competitive as all get out. But pour in some Meaningful Use incentive fuel and an event like MGMA this week in Las Vegas has the makings of a title bout. We’re right in the mix, naturally, with our Meaningful Use challenge encouraging attendees to ask tough questions of other vendors and come back to our booth to share the answers.

Nevertheless, when we read this story about providers on one software solution attesting with bad data because of system error, we actually felt bad for the vendor – but of course even more so for the doctors.

If some of your providers attest with bad data how do you go back and figure out who was affected? Once you identify who attested with the incorrect data, how do you untangle it? And then how do you rectify the problem with CMS? The point here is we’ve found that Meaningful Use is hard. It’s harder than we thought. In fact, all signs point to health reform efforts getting a whole lot harder before they get easier. Take, for example, the ACO final rule with the removal of its proposed requirement to have 50% of an ACO’s providers also be Meaningful Users. The cracks are just beginning to show.

How can anyone get all of this right? I don’t think we’d ever claim to get it right every time–we don’t, at least the first time. But because we are not just selling software and instead providing cloud-based services, we can see everything in real time. If we are wrong nine times out of ten, we can get it right on the tenth time. In other words, a single instance of cloud-based software allows us to self-correct as needed and very quickly. None of this–ICD-10, MU Stage 2 & 3, ACOs, etc.–is going to make our lives easier but we have to make it work. Because our outcomes are tied to the outcomes of our clients, ultimately we’ll get it right because we have to. And, if needed, we can push out a fix to everyone in record time.

This all leads us to the latest installment of the Meaningful Use dashboard data. In the interest of transparency we have been revealing our data every two weeks. This time around we can say we are nearly halfway there – or as our boss might put it, only halfway there (so keep working!) – with 48% of our Medicare MU providers attesting. We’re happy to be making good progress and even happier for our providers getting checks for doing the right thing. We try to give them all the tools they need and get them on the right path and clearly they are taking to it. Our numbers, by the way, are way beyond the single digit national numbers we’ve seen reported. Not bragging. Just pleased it’s working.

On Monday night in Las Vegas, our intrepid CEO Jonathan Bush made a big splash at the hotspot Tao on the Las Vegas strip.  As you might hear or read elsewhere, he literally opened the kimono on our dashboard. Yes, it was classic Vegas showmanship but there was a serious point he was making—as serious as a man can be in a floral kimono: Here’s our data. We’re putting it out there. How well are other vendors doing for their providers? Why isn’t the entire industry opening its kimono so providers can see how this Meaningful Use thing is going?

If there is one thing that you can count on hearing an earful about from us pediatricians, it is the challenge of providing vaccines to our patients while keeping our practices financially viable. With the exception of personnel costs, vaccine purchases represent the largest portion of overhead for almost all pediatricians. This is due in large part to the happy fact that we have many more lifesaving vaccines we can provide to our patients and the not-so-happy fact that most of these newer vaccines are much more costly than their predecessors.

As physicians who care for children, we recognize that the provision of vaccines to our patients is perhaps the most important service we can provide. This is because vaccines protect both the patient we are seeing in our office at the point of care as well as the entire community through the effect of herd immunity. In fact, out of all the thousands of services provided in any medical setting, vaccine provision is the only service given to an individual that benefits the rest of society. It is truly a linchpin of public health.

However, the sustainability of this service is greatly threatened by the financial reality that so many vaccine providers (mostly pediatricians who are already at the bottom of the income food chain) are losing money trying to do this important public health mission.

One of the most challenging variables impacting on this issue is that of payer reimbursement for vaccine products. We know based upon an excellent analysis by the American Academy of Pediatrics that payment for the direct and indirect costs of vaccine products must be 17 to 28% above the acquisition cost basis in order for one’s vaccine business to be viable and sustainable. Heretofore, vaccine providers had no mechanism to see the larger field of reimbursements by payers for vaccine products so that they could make informed choices and negotiate effectively with payers. Antitrust laws prevent physicians from exchanging information about what a specific payer will reimburse for a specific charge.

VaccineView changes the game entirely. (See the press release here.) With this powerful new tool, sunshine is cast onto a previously shadowed field where vaccine providers have struggled to remain viable. Like PayerView, VaccineView allows anyone and everyone to transparently see how well or poorly providers are doing by vaccine type and practice size by looking at payer performance relative to the accepted standard of acquisition cost, plus 17%. From the 158,983 charges analyzed from January 2009 to December 2010, an astounding 47.2% of payments for the eight childhood and adolescent vaccines analyzed were below that standard—cold affirmation of what many of us have suspected for years.

Never before has such a tool existed that so plainly and unequivocally shows what reimbursements for vaccines really are across such a broad cross section of practice sizes, vaccine types, and payers. This tool will tangibly support individual physicians and practices that provide vaccines as they negotiate with payers. It will also allow organizations such as the AAP to more effectively advocate for fair and appropriate vaccine reimbursements. athenahealth’s newest tool has the promise to make a real difference in helping us do this important work to support public health!

It’s been a couple of weeks, so we are back again with a Meaningful Use Dashboard update. Last time around we told you about the MUES Team of eight athenistas that takes on the attestation process for physicians, a sort of last pass of the baton before crossing the finish line. Before that, we shared a post about how we overcame problems like the clinical summaries. And before that, on Sept. 8, is of course when we launched the data (that is, opened the kimono) with a post from CEO Jonathan Bush. What’s happened since our last update?

 Here are the details as of this week:

• 39% of our Medicare MU providers have attested, an 11 point increase in two weeks.
• 77.3% of our Medicare MU providers are satisfying the clinical summary measure, a 12.1 point increase in two weeks.
• 49% of our Medicare MU providers are within two measures of attesting.
• 83.5% of our Medicare MU providers are satisfying their menu measures. That is a 7.8 point increase in two weeks – this measure’s performance was hovering at 74 to 75% for about a month.

 There are a handful of drivers behind our performance:

• As of Sept. 30, we have tested connections with all state immunization registries where we have clients participating in our Medicare MU program. 
• As discussed in previous posts, we made changes to the clinical summary workflow in July and August and we think the new data show that our adjustments are really starting to pay off.
• Our account managers are working extra hard with clients as they get close to the finish line, providing tactics and insight to help them overcome their final hurdles.

Over the past months we’ve been telling the story of just how we support our clients on the path to Meaningful Use. It’s been a long, deliberate process and based on these numbers, it’s working just as we hoped. For a better idea of what’s been happening behind the scenes here, we made this video of what we call in shorthand, “The MU War Room.” 

As you know, we are rapidly approaching another major deadline within our industry. While the transition from ANSI 4010 to ANSI 5010 hasn’t received nearly as much airtime as “Meaningful Use” for example, it is a massive industry change, nonetheless. 

How massive? The transition will reset the entire structure underpinning all electronic healthcare transactions (i.e., EDI, ERA, Eligibility, CSI) from the “4010” format to the “5010” format. This shift will improve communications across the entire health care network and becomes the standard on January 1, 2012. The Department of Health and Human Services has mandated the change.

In case you glanced quickly past the date, that shift, you may say that tectonic shift, is less than 90 days away.

As you can imagine, this industry change has enormous implications for athenahealth, athenahealth clients and the entire health care market. Thanks to our cloud-based model, 100% of our clients are already using a 5010 compliant version of our practice management services that we updated at no additional cost. 

Here’s what’s in motion:

• We started our homework in 2009. First, we built out the changes in our software/connectivity solutions which includes over a thousand updates to our embedded on-demand rules. Our EDI and development teams have worked diligently over the last year to understand the requirements for the new transaction formats as described in hundreds – potentially thousands – of pages of HHS documentation. 
• We kicked off our robust testing plan early this year and we constructed it to ensure we and our clients are prepared for the looming deadline. Our back-office team is actively testing with payers and clearinghouses, as well as looking for new opportunities for rules.
• We’re also working closely with all of our payers to understand their conversion plans. Since the new formats affect payers and providers, the conversion requires a tremendous coordination effort that extends far beyond our business alone.   
• We are closely monitoring client financial performance (claim submission, claim payment, DAR, denial rate, as well other key metrics) to make sure it is as seamless as possible. If one client receives a payer denial related to 5010, we can write a rule and roll it out to our entire network instantly – so no client has to experience that denial again.
• We did all this work so our clients don’t need to worry about understanding the new requirements, implementing the changes or testing with payers and clearinghouses.

As we have tackled Meaningful Use—maybe you noticed that we are sharing our data on our Meaningful Use Dashboard—athenahealth is at the forefront of this industry change too. 

Also like MU, we are shouldering the burden of something extremely complex and made it nearly seamless for our customers. Yet again, we are living up to our mission of being the most trusted business service for medical groups. To the extent the payers are ready for the 5010 implementation New Year deadline, so are we. Therefore, so are our clients.   

But here’s the kicker. While we are ready, several payers may not be ready.  As you can imagine, it’s those payers that present the most risk and we are continuing to work with them. That said, we can submit to payers in whatever format–4010 or 5010–they need so our clients won’t feel any impact.

As we start migrating claims, Eligibility, CSI, ERA, etc. from 4010 to 5010 over the remaining months of this year, there will be some turbulence. Here at athenahealth we are planning educational sessions to review the conversion plan, timeline, customer impacts, etc.

After the transition occurs in 2012, practices will need to closely monitor claim submission, denial rates, DAR, and claim payment to reduce the financial impact to their practice. We’ll be doing this for our practices. Will your vendor do that?

Oh, and by the way, 5010 compliance is just the next step to preparing for the October 2013 cutover to ICD-10 compliance. More on that later.

If you somehow missed it in the news cycle of the past couple of weeks, September 11-17 was National Health Information Technology Week. Yup, it’s a real thing…..thanks to the President, who signed a proclamation, and the Senate, which unanimously passed a resolution. It even has its own hashtag: #NHITWeek (of course, so does anything you can type). This year, HIMSS, ONC and others hosted a packed schedule of events with a focus on consumer (patient) engagement, care coordination, and of course, Meaningful Use of EHR. 

HHS kicked off the week with what can only be described as an HIT pep rally, complete with its own cheer of  “Put the ‘I’ in Health IT!” (Never mind it’s already there!) In an effort to better engage patients/consumers, the ONC introduced a pledge to instill a sense of ownership and responsibility about maintaining health information and leveraging technology to improve health care for everyone. Next year, I just might bring pom-poms.

That day, athenahealth usability team members Lauren Zack and Trisha Flanagan joined me on Capitol Hill to participate in a panel on HIT and patient safety sponsored by the Institute for e-Health Policy.  The panel was timely because a few of us are waiting for the soon-to-be-released Institute of Medicine (IOM) study on the impact of HIT on the delivery of health care  commissioned by HHS.

During the panel discussion, Lauren recommended that usability and patient safety should be integral to software development and not just after-the-fact concepts. Her points were well-received. Watch a video of the event here.

One of my favorite events was a roundtable hosted by the National Health IT Collaborative for the Underserved on “Vulnerable Populations and HIT” (“vulnerable” is shorthand for “rural, underserved, disparate, and minority communities”). The White House has made the reduction of health care disparities a top priority and the 30 to 40 folks in attendance were gathered to comment on the Federal Strategic Plan to Reduce Health IT Disparities. The wide range of perspective included leaders from telecommunications, HHS/ONC, education, research, and large health systems. There was even a librarian. The great variety of participants generated a comprehensive discussion about workforce, HIT infrastructure, culture and more. As a vendor that has deployed expertise and services to doctor’s offices all over the country for over a decade, it was refreshing to see the room excited about leveraging Internet access and cloud technologies to solve a major problem.

So that was HIT Week. October is already off to a busy start and I’m back in D.C. If you’re here on Wednesday the 5th, our CEO Jonathan Bush will be presenting on a Capitol Hill panel about the use of data to transform health care.  You can sign up here.  And I’ll be participating in an HIT Policy Committee Meaningful Use workgroup public hearing on the same day with our CTO, Jeremy Delinsky. We will talk about Stage 3 objectives from the vendor perspective.

Stay tuned for more dispatches from inside the Beltway, including some tweets and maybe a blog post from Wednesday.