Healthcare IT

  • Annual health IT costs for medical practices costs now top $32,000 per doc

    Health IT costs for physician practices are soaring, yet there isn’t much evidence that all the spending has been worth it, a new report suggests.

    In its annual report on cost and revenue for physician practices, the Medical Group Management Association found that physician-owned multispecialty practices spent $32,592 per full-time doctor on IT hardware, software, maintenance, staff and other needs in 2015. That is up 42 percent from $22,944 in 2009 and 19.5 percent from $27,285 in 2011, the Englewood, Colorado-based MGMA said.

    The 2015 costs break down as $9,405 for IT staff and $23,187 for equipment, maintenance and supplies.

    Source: Medical Group Management Association

    In recent years, providers have been hit with multiple federal mandates and programs that have necessitated health IT spending. These include the transitions to the ANSI 5010 standard for HIPAA transactions in 2012 and to ICD-10 in 2015, as well as Meaningful Use and the Physician Quality Reporting System. “It’s the sheer number of them,” said Robert Tennant, MGMA director of health IT policy.

    And there has not been a solid return on investment, according to the report.

    “They spend this money and they’re really not sure that they’ve gotten what they were promised,” Tennant said. The improved patient outcomes, reduced hassle and lower costs simply haven’t materialized, he explained.

    “There’s really no correlation between the [Meaningful Use] program and improved patient care,” Tennant said. Usability has been a well-documented issue with electronic health records, too.

    “Productivity is suffering,” Tennant added. “There’s a level of frustration with technology that I’ve never seen before.”

    Healthcare has long been perceived as being far behind the rest of the business world when it comes to adopting information technology, but Tennant didn’t think that the need to play catch-up has been a major factor in the escalating costs.

    “To be competitive in today’s healthcare environment, you have to offer all the bells and whistles,” he said. For medical practices, that means patient portals, 24/7 access to test results and the ability to schedule appointments and pay bills online. “In the D.C. market, that’s a huge selling point,” the Washington-based Tennant said.

    Plus, he added, new physicians, who grew up in the digital age and used EHRs in medical school and residency, do not want to work at paper-based practices.

    Photo: RoBeDeRo/Getty Images

  • Where’s the value in accountable care?

    From left: Christina Miles of Aon Hewitt, David Van Houtte of Aetna, Dr. Katherine Schneider of Delaware Valley ACO and Dr. Greg Carroll of GOHealth Urgent Care

    Accountable care is supposed to be about paying for value. But six years after passage of the Affordable Care Act heralded the shift away from fee-for-service, Dr. Greg Carroll, corporate clinical leader of GOHealth Urgent Care, has an important question: “Where’s the value?”

    That was the subject of a lively panel discussion at MedCity CONVERGE this week in Philadelphia.

    “We really need to get to the level of what motivates behavior change,” said Carroll. After all, everybody is a little bit different in what motivates them, Carroll explained, and the movement to performance-based payment requires behavior change on multiple levels.

    Those paying the bulk of the bills in healthcare for patients not old enough for Medicare — employers, via insurance premiums — don’t seem to get value-based healthcare yet.

    Christina M. Miles, senior vice president for delivery system transformation at human resources consulting firm Aon Hewitt, presented some eye-opening data from a 2015 company survey. Just 11 percent of respondents said they “fully understand” healthcare provider performance from a cost perspective, while 9 percent said the same about provider performance from a quality standpoint.

    In each case, more than 31 percent were not even aware of clinically integrated performance initiatives within their company plan’s healthcare networks, Miles said. “In most cases, the majority of employers just aren’t there.”

    Those in on the front lines are not discouraged, though. “Value-based contracting is one of our key corporate pillars at Aetna,” said David Van Houtte, of the payer’s Accountable Care Solutions division.

    Aetna currently puts about 40 percent of its total healthcare dollars into value-based contracts, Van Houtte said. The goal is to have that at 75 percent by 2020.

    That aggressive shift parallels efforts at the federal level. The Centers for Medicare and Medicaid Services has said it wants 85 percent of all Medicare fee-for-service reimbursements tied to quality or value by the end of 2016, including shifting 30 percent of reimbursements to alternative payment models — think bundled payments or Accountable Care Organizations. The goals rise to 90 percent and 50 percent, respectively, by 2018.

    Miles said to “be encouraged” that for the first time, CMS is driving much of the evolution.

    It has providers rethinking what they do, for sure.

    “My full-time job is basically change management,” said Dr. Katherine Schneider, president and CEO of Delaware Valley ACO, comprising Main Line Health, Jefferson University and Hospitals, Holy Redeemer Health System, Doylestown Health, and Magee Rehab in the Philadelphia area. It’s one of 77 ACOs contracting with Aetna, she said, and the organization also participates in the Medicare Shared Savings Program.

    The hope for Delaware Valley ACO was to get 5,500 lives in MSSP in its first year. The organization actually enrolled 35,000 the first year, and now is above 130,000, plus 100,000 more commercially insured members in ACO programs. Participating organizations earned $6.5 million from CMS for saving Medicare $13 million last year, Schneider said.

    She offered some words of advice to those contemplating their own ACOs. “The ACO is all about the C. It’s the care model that matters,” Schneider said.

    “We’re very primary care-centric even though we’re part of an integrated health system,” she added.

    Miles also emphasized primary care and prevention. “The hospital bed becomes a cost center rather than a profit center,” she said. The same is true about the emergency department.”

    “We tend to forget the patient,” Miles said. “They’re the end user.”

    Miles noted that employers today are hesitant to require their employees to choose a PCP, a throwback to the unpleasant HMO era. She surmised that it may be time to go there again.

    “We have to keep our eyes on the True North here,” Miles said. That’s the Triple Aim of safer care, improved population health and lower costs.

    Photo: Meghan Uno/Breaking Media

  • Proper transitional care management can boost practice revenue

    The pro: Billing for transitional care management — services rendered for certain patients during their transition from an inpatient hospital setting to their home — boosts income for physician practices. In 2013, the Centers for Medicare and Medicaid Services began paying for TCM, which could, in some cases, yield physicians more than twice the reimbursement of a hospital follow-up office visit.

    The con: Operational challenges make it difficult to meet regularly requirements.

    These requirements state that physicians must provide initial contact with the patient within two business days of hospital discharge. Within seven or 14 calendar days (depending on the patient’s complexity), they must provide a face-to-face visit. In addition, transitional care management is for 30 days of services, so physicians can only bill TCM once every 30 days.

    Dr. Lonnie Robinson, a family physician at Regional Family Medicine in Mountain Home, Arkansas, said that without the help of technology — specifically an easy-to-use TCM app called Phyzit — he would have had a difficult time meeting TCM requirements. In a busy practice of eight family physicians and three nurse practitioners, he said it’s difficult to track hospital discharges and meet the deadlines for patient contact. That’s where the app helps. And now he bills for TCM at least once a week.

    “Care coordinators don’t have to sit down and figure out who’s due for a phone call, who’s due for an office visit and what day the billing has to take place for this all to work properly,” said Robinson.

    Local hospitals send patient admission and discharge information to care coordinators working at the practice who then enter this information — along with patient demographic data — into the app. Coordinators also monitor the state’s health information exchange for admission and discharge information. The app handles the rest of the work for them, notifying them as deadlines approach.

    “The care coordinators tell me it’s a good value for the price, and they would like to keep it,” he said.

    Since Robinson began billing for transitional care management in March 2015, he has noticed a 40 percent increase in revenue for eligible hospital follow-up visits and a decrease in readmission rates from 13.1 percent to 8.2 percent. He said the cost of the app is minimal considering the short- and long-term payoff to ensure compliant TCM billing.

    “I think TCM fits into the bigger picture of value-based reimbursement,” said Robinson. “A lot of our incentive programs are tied to a shared-savings model — especially Medicare. TCM improves your chances of achieving a Medicare shared-savings bonus if you’re involved in an ACO.”

    Photo: Flickr user forayinto35mm

  • Get ready for exponential growth in telemedicine in 2017

    As reimbursement evolves from fee-for-service to alternative payment models, incentives will shift from treating sickness to keeping the population healthy. New investments will be made in technologies that reach into the home and enhance care team communication. 2016 saw an acceleration of telemedicine/telehealth. 2017 will see exponential growth.

    Telemedicine is hard to define. It could be real-time video teleconferencing between clinicians (a consult), between a patient and clincian (a visit), or group to group (tumor board discussion). It could be the transmission of a static photograph, such as the poisonous mushroom/plant teleconsultation I do 900 times per year. It could be secure texting to coordinate patient care.

    Patients might provide care teams with objective data from devices in their homes. Patients might answer surveys about their mood, activity or pain.

    All of these are telemedicine.

    Many companies will offer cloud-based tools and technologies to support these new workflows. Some organizations will use bridging technology to link together every kind of endpoint (Skype, Facetime, commerical telemedicine apps) with every kind of endpoint.

    There are so many use cases and so many possibilities that one approach will not serve all needs, so most organizations will have a multi-faceted strategy.

    There are some unanswered questions:

    1. How do you bill for telemedicine? There is a new CPT code, but it’s not clear how it should be used.
    2. How do you address multiple conflicting state laws when consulting across borders?
    3. How is the record of a virtual encounter stored and who is the steward of the record?

    For my personal telemedicine practice, toxicology consultation, I use an iPhone and email to review cases and images. No protected healthcare information is exchanged.

    I am credentialed by Beth Israel Deaconess Medical Center for telemedicine practice

    I am malpractice-insured for telemedicine practice.

    When consulting across state lines, I provide advice to licensed physicians in that state and never interact with patients directly (or prescribe medications).

    I do not bill for these services. They are a public good.

    Medical records are kept by the physician consulting me, and that physician is the steward of the record.

    As hospitals expand to serve patients at the national and international level, as payment models require more home care/wellness care and as consumers demand the same kind of convenience from healthcare that they get from other industries, telemedicine will expand and mature.

    Telemedicine at BIDMC (part of Media Services) reports to me and I’ve requested additional staffing and investment for 2017. Technology, business needs, and customer demand are aligning to make telemedicine an increasingly important service offering for clincians and hospitals.

    Photo: Bigstock

  • Quietly, startup Fitabase hits major Fitbit health research milestones

    Since early 2015, investigators have ResearchKit for collecting data from Apple devices. Then, ResearchStack came along for for studying Android users.

    But the research community has been able to pull in information from Fitbits and other connected, wearable devices for four years with the help of a research platform called Fitabase.

    This week, Fitbit announced that Fitabase, made by San Diego-based startup Small Steps Labs, has now collected more than 2 billion minutes of Fitbit data for research purposes. Fitabase also has supported more than 200 research projects since its 2012 founding, the company also disclosed.

    “What we’ve built is kind of the missing piece for research,” said Fitabase CEO Aaron Coleman. The platform collects and de-identifies data from Fitbit users and offers data pools to academic researchers, including many in healthcare. “This removes a lot of privacy concerns,” including those around HIPAA, Coleman said.

    “This is a technology that bridges a consumer device like Fitbit with the needs of research,” Coleman said. “Researchers are loving this new paradigm of research.”

    That’s important because millions have purchased and regularly use activity trackers. The data these wearables collect provide insights about movement, heart rate and sleep patterns that previously had not been available, plus people actually enjoy wearing their Fitbits.

    “It was really difficult to get people to use pedometers,” Coleman noted. That made it tough for researchers and clinicians alike to collect good data and, more importantly, improve health.

    “Devices help people better tailor their activities and their health,” Coleman said. “Interventions shouldn’t be the same for everyone.”

    For example, Fitabit is helping researchers determine how quickly people regain their previous level of activity following surgery. “They can tailor interventions to people who need it most,” Coleman said.

    So what about the “2 billion minutes” of Fitbit data? “We provide the researcher with de-identified data at the minute level,” Coleman explained. Each person’s activity levels can vary at different times in the day. Having this insight allows researchers — and, ultimately, healthcare professionals and caregivers — to schedule interventions when they are most likely to be effective, according to Coleman.

    Coleman pointed to a research project at Arizona State University, where Eric Hekler, director of the school’s Designing Health Lab, is applying engineering strategies to study what Hekler calls “precision behavior change,” a complement to precision medicine. Hekler and research partner Daniel Rivera, director of the ASU Control Systems Engineering Laboratory, are testing “health interventions that are adaptive and individualized, versus static and generalized,” according to a Fitbit statement.

    Coleman himself also has applied individual Fitbit data to control the level of difficulty in an app called Tappy Fit, a Flappy Birds-like mobile fitness game.

    Photos: Fitabase, Fitbit

  • The exciting convergence in healthcare also raises some tough questions

    In the healthcare industry, be attentive to where medicine and technology intersect—where people from the clinical and pharmaceutical worlds rub elbows with computer scientists and programmers.

    That’s where Shelley Zhuang, founder of investment firm Eleven Two Capital, said her company looks to invest during one of the many discussions that took place this week in Philadelphia during the MedCity CONVERGE conference. But Zhuang’s investment strategy also serves as a good summary of the conference itself, where questions of where the healthcare industry would be in five or 10 years were regularly analyzed in terms of where new or burgeoning technologies might pull it.

    There’s excitement in the healthcare sector right now given what companies, large and small, are now researching. At CONVERGE, Nishan Kulatilaka, associate director of product management and applied technology at pharmaceutical giant Merck, talked about how Bitcoin’s blockchain technology could be used to streamline transactional histories and blood test information for patients. Sampriti Bhattacharyya, the founder of Hydroswarm, discussed how her startup’s underwater drones communicate with one another to uncover some of the mysteries of the ocean, and how similar technology could be applied to diagnostics and surgery.

    But there’s also a degree of uncertainty afoot, driven in part by that same disruptive excitement that the potential promises of new technology bring. At a panel discussion on the promises of genomics and what lies ahead in genetic testing patients for markers of disease—the very panel where Zhuang shared some insight into Eleven Two Capital’s investment strategy—the consensus appeared to be that no one is quite sure how much utility patients and physicians get out of new genetics testing, or how much insurance premiums might cover. Consumers themselves are also something of a code to crack: Most health consumers today consult their smartphones with medical questions, but when they’re sitting in the waiting room of their primary care physician, are they getting the information they need in the moment to make informed health decisions?

    “We don’t really know to some degree how consumers make decisions in healthcare,” said Kirk Pion, vice president and “innovation champion” at UnitedHealthcare.

    Moreover, there are still conundrums within the health sector to be worked out now that the Affordable Care Act is being implemented. CONVERGE attendees heard from AdvaMed president and CEO Scott Whitaker and his southern drawl about how the medical device industry fought for a two-year reprieve from the 2.3 percent medical device tax that was part of the law. It’s a measure that was necessary, Whitaker argues, to encourage larger companies with capital to spend to continue investing in smaller companies pushing the boundaries at the intersection of medicine and technology.

    Taken altogether, CONVERGE is not only the name of a MedCity conference, but an accurate way of describing the shifts that are happening within the health sector right now. It’s too soon to tell precisely where advances in the blockchain or costs of genetics testing ultimately lead to when it comes to pushing the medical field further. All of these forces are intertwined, intermingling, and making healthcare in the 21st century ever the more interesting. But the singular focus, throughout the whole of the conference, was kept on the most important person the healthcare industry talks to every day: the patient.

    As Whitaker said during a one-on-one conversation, the question of technology and medicine is important for health workers to get right because “it impacts patients’ lives at the end of the day.”

    Photo: Free Images/ Ear_Candy

  • Evolve IT and Innovate to Transform Healthcare at the Speed-of-Now!

    Organizations are facing challenges to support outcome based medicine initiatives while simultaneously trying to cope with “the information generation” that wants healthcare at the speed of now.  Healthcare IT must transform either through evolution or innovation to help meet their organizational business imperatives, expectations of their patients and drive insight to improve the quality and efficiency of care delivery.

  • How Nursing Informatics Has Improved Patient Care

    Ellen Makar, MSN, RN-BC, CCM, CPHIMS, CENP, a passionate patient and clinician advocate discusses her belief that the nation can support the quadruple aim of better health, better care, cost effective care, and improved clinician experience through thoughtful deployment of innovative technologies and proper training and support for their effective use.

  • Making Sense of Healthcare Big Data

    As the amount of data in healthcare continues to grow, data scientists are working to create solutions that address complex problems in healthcare. We are joined by Kevin Petrie, a technology evangelist at Attunity who has worked on solving problems inside and outside of healthcare with data scientists . Kevin joins us to talk about […]

  • Inside North America’s first all-digital hospital

    The digital experience at Humber River Hospital in northwest Toronto begins the moment patients arrive. The sleek, square building feels like a small airport, with each registration area designated with a letter. Before arriving, patients look online to find out their check-in zone. Humber River is North America’s first all-digital hospital. Inside its corridors, there […]