With all the action in the health IT industry these days, an electronic transaction format conversion has to be one of the least sexy topics out there. But the latest transition has been fraught with danger.

Heading into the last quarter of 2011, the ANSI 5010 conversion had the potential to have a huge negative impact on providers. An unsuccessful conversion would have been disastrous for medical billing: Claims would have been unreadable by payers and payments could have been sent to the wrong locations. In an extreme case, the past decade’s successful migration to electronic transactions could have unraveled, forcing providers back to paper in order to get paid.  

Every month, 15 million electronic claim, remittance, eligibility and claim status inquiry transactions flow through athenahealth—and before the ANSI 5010 conversion, we knew the change would impact nearly every one of those medical billing transactions. So, we slated a gradual implementation over a full year.

And yet, despite our best efforts to push early adoption with payers, we had only three payers ready for claim submission in the 5010 format as we headed into the third quarter of 2011. Three payers, accounting for less than 1% of our volume.

Fast forward seven months.  

Although the Centers for Medicare and Medicaid Services (CMS) have twice postponed enforcement of these standards (currently scheduled for June 30, 2012), more than 97% of athenahealth’s transactions are now exchanged in ANSI 5010. We’ve since moved on, tackling our 2012 initiatives, including preparations for the massive ICD-10 code update. And those remaining 2.1% of transactions are awaiting payer or intermediary readiness. So, we’ll continue to move these payers and monitor them throughout this year, and probably into 2013.  

So, how did the ANSI 5010 conversion go?

It hurt, but it could have been so much worse.

We started Q4 2011 with less than 1% of claims submitted in 5010—by the first week of January, 2012, we had  more than 85% of claims in the new format. This rapid conversion wasn’t without serious impacts to our providers: 

• Without warning, in November, Medicare had unveiled 5010-only enrollment for providers. This meant conversions within each state needed to be completed before any new athenahealth providers could start submitting claims in 5010. If the associated intermediaries could keep up with the testing, and 5010 approvals were done in a timely manner, this could have been manageable. But many couldn’t keep up and some of our new providers suffered as a result. Despite this, we were live with most Medicare carriers by mid-November and fully live in all states before the conversion deadline, minimizing the impact on our providers.
• With internal communication gaps and the implementation of external tools, many payers couldn’t tell athenahealth how they were interpreting the standards in advance of moving to production. Because of this, athenahealth’s front-end rejection rate, which typically hovers around 1.5%, peaked at 2.4% in January, 2012. While we weren’t thrilled, the only other vendor we’re aware of that shared this metric was happy with their 5% rejection rate. We credit this manageable increase to our production testing process, which mitigated risk by submitting the bulk of claims in 4010 while gradually increasing the 5010 volume with each payer who supported it. 
• Payers and intermediaries who didn’t have careful controls processes in place were, at times, unable to answer basic questions about submitted claims: Who submitted them? How many claims are there? or What is their status? This widespread issue resulted in false compliance warnings, processing delays and reporting errors, and some providers were hit harder than others. Again, through vigilant monitoring and escalation of missing claim research with payers and intermediaries, we were able to resolve these issues. The situation then improved dramatically in February. Some of our providers had significant payment delays, which would have been more extreme had we not detected issues early, analyzed the available data and resubmitted affected claims once we became confident of the best way to move forward.     

Here’s why our cloud-based services ease transitions like these:

• Our cloud-based model allows unparalleled visibility into the financial health of our clients. We’re invested in the whole claim lifecycle—we don’t just pass through a claim and hope it gets to the payer. We confirm receipt, track claims’ progress and ensure remittance is received. And we’ve set up alarms to let us know when  claims don’t get on file as expected. Within a week of a claim submission, if we haven’t seen acknowledgement as expected, we begin escalating issues with the intermediary and payer. 
• We had a testing cycle that was so thorough it elicited ridicule from some trading partners early on. Yet, by the end of the implementation, several payers and clearinghouses were thanking us for our help in their implementation. As an early adopter, we were able to help them detect issues and address major problems before the rest of the pack was ready to start testing. For example, in January alone we encountered nearly 50,000 false rejections from clearinghouses or payers who needed to update their systems and reprocess our clean claims.
• We allocated the appropriate time, money and people to the change, monitored maniacally, and reacted quickly. Our “war room” processed hundreds of issues with our Development and Rules teams present in the room so that a new requirement or issue could be swiftly implemented as soon as it was defined.

We’re already working on preparations for the big switchover to the ICD-10 code set and tapping into the lessons we learned from 5010 to make it go as smoothly as possible. As always, we want to help providers focus on their patients by serving up the right information at the right time, in the right place.

Do you feel like you’re working harder for less pay? When you were young, did you have dreams of being a noble caregiver, only to spend your days worrying about reimbursements or getting sued or the next cumbersome government regulation? Are your collections late? Did life NOT improve after the local health system acquired your practice?

Okay, forget being in the health care business—we are all patients sometimes, too. Do you feel like an actual human in the exam room or a numbered paper gown with dollars signs attached to it? Has trying to get well ever nearly bankrupted you?

Well, you’re not alone.

This is a tough time to run a medical practice—or be a patient—and we all know that is why, in fact, athenahealth exists. We are here to make it suck less.

For a light-hearted look at your plight—and ours—we have a little video. It’s a parody of a song from the Tony Award-winning musical “Avenue Q.”

Hang on. Things get really great at the 3:29 mark….

Prior to the User Conference, we told you about our trip down to Huntersville, NC to talk with the folks at Rosedale Infectious Diseases. Most of the patients there are HIV-positive and we talked to a few who could see the benefits of an EHR.

Since then, Rosedale practice manager Dale Pierce won the athenahealth Vision Award along with Dr. Abraham Verghese during the User Conference here in Boston last week.

Here’s our video about Rosedale:

We concluded our 2012 User Conference two days ago here in Boston. While we emphasized a theme of care coordination this year, the importance of human interaction in the exam room was also top-of-mind.

During his keynote speech on Monday morning, Dr. Abraham Verghese reminded the more than 800 attendees and a few hundred athenistas how critical it is for a physician to be present during the exam, to converse with a patient and not interact through technology like an EHR. Despite the obvious benefits of technological innovation, such as advanced imaging, reliance and excessive focus on electronic tools can get in the way of “attentiveness” to the patient. And as Dr. Verghese said, “This is the great danger of health care in our time.”

For his contributions to “making health care work as it should,” Verghese was presented the 2012 athenahealth Vision Award.

The other recipient of this year’s Vision Award was Dale Pierce, practice manager at Rosedale Infectious Disease in Huntersville, NC. Rosedale cares for 2,000 patients, most of them HIV-positive, at a practice that does everything it can to make patients feel as comfortable as possible. They do it by being attentive in the way Verghese urges.

“The difference with Rosedale is that they don’t just treat the disease, they treat you as a patient,” Rosedale patient Sharon Cox told us during our recent visit to the practice. “They care about you emotionally. They care about you psychologically and spiritually and it kind of feels like a family.”

The second keynote speaker of the 2012 User Conference was Dr. Farzad Mostashari. As the National Coordinator for Health Information Technology, Mostashari comes at health information technology from the goal of bridging the gap between industry and government with the ultimate result of better medical care—and, thus, healthier Americans—through the use of EHRs.

Mostashari also tied in the importance of keeping the patient in focus. He noted, for example, the Meaningful Use measure that requires a doctor to give patients a clinical summary of the office visit, a requirement that would seem to provide the feedback patients want today and that Verghese champions. In commenting on this new sharing of information, Mostashari said, “A lot of you are saying ‘Gee, this is a chance to educate and have a process for understanding what the patient knows of their information. And you know what? Maybe we should make it easy for them to get their records electronically’.”

For all of you who attended the 2012 User Conference, we hope you learned a lot to bring back to your practices. Come back next year. If you’re not a client, become one so you can sign up for the 2013 conference.

Remember the beast?

Well, we had to let him go, back into the Everglades. Sadly, he’s gone. While athenahealth employees may love snappy, silly, highly metaphorical expressions of our mission, it seems that doctors … well, not so much.

As one doctor told me at one of our conferences in Maine last year, “If you want to turn me off, flash a big bunch of colors and an animated octopus with happy people in my face. If you want to turn me on, give me some Courier 12-pt. font with data I haven’t seen anywhere before!”

I think he’s right. Of course he’s right.

This is what turns me on most about athenahealth: Find me another living data set with 32,700 providers seeing a pool of 25 million patients in a single, Oracle database where one administrator has the right and skill to adjust and administer the fields, which are captured 24/7! We are sitting on so much untapped truth and our marketing has been … well, really rather cute. And not that serious.

So here is Version 1 of the new, more mature athenahealth.

It’s a campaign we call “This is How.” Yes, we expect it to look more boring, at the same time that our command of the content we sit on (and our confidence) improves.

Why Were We So Flashy?

Partly, I think the flashiness was due to the worst fears of flash-haters: that we didn’t actually have much to say. Even if we had a lot to say and just didn’t understand what it was, we felt we had to say it all in lots of colorful ways.

Also though, the kinds of people we need to make athenahealth function smoothly are young, brilliant and hungry for an emotional connection to their work. It seems we were advertising to ourselves. It may have felt good but it wasn’t on mission for our clients.

Our clients feel a connection to their work, too and it is emotional–but there is a stewardship component to it that we are only just starting to feel. Our clients started their careers by taking the Hippocratic Oath … “First, Do No Harm”…  Nifty, high-speed Internet companies that soar to the moon with new inventions can also fail spectacularly, and many do. With cool game apps and nifty smartphones, this is just fine. Not so with human lives.

During our 13 years, we have accumulated one of the most powerful assets for innovation in the history of health care: the ability to surveil, in real time, what happens and what doesn’t … what works and what doesn’t.

From Flash to Facts

So, rather than spend tens of millions of dollars yelling the same three things we need you to hear, in ever louder and more colorful ways, we have decided instead to spend more, most of it over time, on a whisper of new truth.

We know how many times a doctor’s orders have actually been updated in the charts as a result … and no one else does. We know the biggest black holes and no one else does. We know how long it takes for a result to come back if it is going to do so. We know that certain vaccinations are under-reimbursed nearly half the time when the total cost to the physician, beyond the cost of acquisition of a specific vaccine, is considered. 

We know so many things like this … and we want to have a reason to know more … and to share it. So from now on, we have decided to make that part of our marketing budget.

Last year, for the first time, we saw a Ph.D. defended with the help of athenaNet. The candidate used athenaClinicals EHR data to understand the optimal organizational structure of a medical practice. This year, we want to try three more peer-reviewed studies.

We want our marketing to be as “on mission” as account management and operations. We want to wipe out the huge mistake of buying software for health care in 2012. We are growing up a little each year and this year, that means we will learn to be patient and on mission with our marketing.

We hope you like it… but we REALLY hope you use it.

PS… Please feel free to follow the link above to watch “This is How” and then come back here and call BS if you think it’s still too flashy!! Still miss the Beast? I heard he didn’t last long down there in the Everglades.