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Karen DeSalvo and Jacob Reider Leave ONC

Posted on October 24, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s been a tumultuous few months for ONC and it’s just gotten even more tumultuous. We previously reported about the departures of Doug Fridsma MD, ONC’s Chief Science Officer, Joy Pritts, the first Chief Privacy Officer at ONC, and Lygeia Ricciardi, Director of the Office of Consumer eHealth, and Judy Murphy, Chief Nursing Officer (CNO) from ONC. Yesterday, the news dropped that Karen DeSalvo, ONC’s National Coordinator, and Jacob Reider, ONC’s Deputy National Coordinator, are both leaving ONC as well.

Karen DeSalvo has been tapped by HHS Secretary Sylvia Mathews Burwell to replace Wanda K. Jones as assistant secretary of health which oversees the surgeon general’s office and will be working on Ebola and other pressing health issues. I think DeSalvo’s letter to staff describes it well:

As you know, I have deep roots and a belief in public health and its critical value in assuring the health of everyone, not only in crisis, but every day, and I am honored to be asked to step in to serve.

DeSalvo’s always been a major public health advocate and that’s where her passion lies. Her passion isn’t healthcare technology. So, this change isn’t surprising. Although, it is a little surprising that it comes only 10 months into her time at ONC.

The obvious choice as Acting National Coordinator would have been Jacob Reider who was previously Acting National Coordinator when Farzad Mostashari left. However, Reider also announced his decision to leave ONC:

In light of the events that led to Karen’s announcement today–it’s appropriate now to be clear about my plans, as well. With Jon White and Andy Gettinger on board, and a search for a new Deputy National Coordinator well underway, I am pleased that much of this has now fallen into place–with only a few loose ends yet to be completed. I’ll remain at ONC until late November, working closely with Lisa as she assumes her role as Acting National Coordinator.

As Reider mentions, Lisa Lewis who is currently ONC’s COO will be serving as Acting National Coordinator at ONC.

What’s All This Mean?
There’s a lot of speculation as to why all of these departures are happening at ONC. Many people believe that ONC is a sinking ship and people are doing everything they can to get off the ship before it sinks completely. Others have suggested that these people see an opportunity to make a lot more money working for a company. The government certainly doesn’t pay market wages for the skills these people have. Plus, their connections and experience at ONC give them some unique qualifications that many companies are willing to pay to get. Some have suggested that the meaningful use work is mostly done and so these people want to move on to something new.

My guess is that it’s a mix of all of these things. It’s always hard to make broad generalizations about topics like this. For example, I already alluded to the fact that I think Karen DeSalvo saw an opportunity to move to a position that was more in line with her passions. Hard to fault someone for making that move. We’d all do the same.

What is really unclear is the future of ONC. They still have a few years of meaningful use which they’ll have to administer including the EHR penalties which could carry meaningful use forward for even longer than just a few years. I expect ONC will still have money to work on things like interoperability. We’ll see if ONC can put together the patient safety initiative they started or if that will get shut down because it’s outside their jurisdiction.

Beyond those things, what’s the future of ONC?

Interesting and Funny Insights Into EHR and Health Information Management

Posted on October 20, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last week I had the chance to attend the Craneware Summit in Las Vegas. It was a really interesting event where I had the chance to meet and talk with a wide variety of people from across the spectrum of healthcare. I love getting these added perspectives.

One of the sessions I attended was an E&M session which provided some really interesting insights into the life of an E&M coder and how they look at things. There’s a lot more to their job, but I tweeted these comments because they made me laugh and illustrated part of the challenge they face in a new EMR world.

I thought these immediate responses to the question were interesting. They came from a crowd of HIM and coding professionals. Overall, they were quite supportive of EMR it seemed.

Many doctors don’t understand this. That’s why so many coders still have jobs.

Too funny.

Said like a true coder.

8 Steps to Creating a Solid EHR Foundation – Breakaway Thinking

Posted on October 15, 2014 I Written By

The following is a guest blog post by Noelle Whang, Sr. Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Noelle Whang
Implementing an electronic health record (EHR) is a huge undertaking, but the work after go live can be even more demanding. Mapping and redesigning workflows is an important aspect of EHR implementation and optimization that is often overlooked, especially after the application has been live for a while.  This seemingly simple but complex task involves diagraming and analyzing all current work processes and adjusting them to include use of a new EHR system or upgrade, or to be more effective with a current system.

Workflow mapping and redesign should occur before implementation and regularly after go live to ensure end users truly adopt the EHR and organizational benefits are realized. Following these eight steps can ease the task of mapping workflows to identify any that should be adjusted to maximize optimization:

  1. Identify what workflows will need to be mapped in detail. “Understanding the full clinical context for health IT to the level of task, resources, and workflow is a necessary prerequisite for successful adoption of health IT,” according to a Perspectives in Health Information Management article. It’s helpful to first map out the entire patient care process at a high level, such as from registration to discharge in the inpatient setting and scheduling to check-out in the ambulatory setting. Documenting how business is performed at a high-level facilitates identifying the more granular tasks that need to be mapped in detail, such as scheduling a patient appointment or placing verbal orders.  It also helps in identifying all the roles involved in each workflow, as these can vary depending on the department or patient process.  For example, discharging a patient from Labor and Delivery may include roles, such as a lactation nurse and pediatrician, not found in other departments.  Remember to also consider departments or patient processes that are often overlooked, such as Materials Management and Respiratory Therapy. Other areas of concentration should be those with lower productivity or that relate to how the organization is going to determine return on investment.
  1. Identify teams to map out each process. After identifying what workflows need to be mapped, establish the team that will do the actual mapping. Usually, individuals who perform a particular workflow or those who are responsible for implementing any redesign changes are best suited to map workflows, as they have in-depth knowledge of the process. For example, select one registrar, one nurse and one physician to map out all workflows in the Emergency Department.
  1. Determine the process for mapping the workflows. Once the team has been identified, determine how information about workflows will be gathered, documented, and visually represented. The process for gathering information can be through interviews, observation, or meetings.  The information can be documented with tools such as Microsoft Word or Visio or simply on paper.  The data can be represented in formats such as a swim lane chart, a flow process chart or other process diagrams.   In my experience mapping out workflows, the most commonly used format is a swim lane chart created through Visio.  And remember: Internal staff will most likely need to be trained on how to gather the data and use the appropriate tools.
  1. Map the workflow as actually performed. After determining how information is gathered and documented, create the actual workflows diagrams.  Document all work as it is currently being performed, including any undesirable behavior such as workarounds or inconsistencies.  For a case study on how one organization created their workflow diagrams, see the following Journal of American Medical Information Association article.
  1. Analyze the workflow. Once the workflows are diagramed, begin the analysis. If a vendor has not been selected, use the diagrams to determine if a particular application fits the needs of your organization, with the caveat that it is neither feasible nor desirable to keep workflows exactly the same after an implementation.  If the application is already in place, the diagrams can be used to determine where problems are occurring, what the root cause is, and how to fix them.  The diagrams can also be used to determine where optimization or efficiencies may be gained.
  1. Document the new workflow. Once the analysis is complete and you have determined what workflows are currently not working for your organization, document the new and improved workflow.  It is a good idea to take the new workflows through a couple of use-case scenarios to ensure that the updates are not causing other problems or unintended consequences.
  1. Update or create policies and procedures. New or updated policies and procedures may be necessary to implement and support the new workflow. This can include determining consequences for any end users that do not adhere to the new workflows.  Note that this also requires thinking about how non-adherence will be identified, perhaps through routine application audits or quarterly in-department observation.
  1. Train staff. After all the hard lifting of creating the workflow diagrams, analyzing the processes and updating the workflows, the last step is to train end users on the new workflows, policies and procedures.  Remember to convey why the changes are occurring, and if possible, tie the reasons to big-ticket items such as increasing patient safety and satisfaction.

It’s easy to focus entirely on big tasks such as vendor selection and system configuration when implementing an EHR, but neglecting workflows can have serious negative impacts, including costly reconfigurations and operational inefficiencies.  It’s like building a house where each individual room is perfect, but the doors are all in the wrong place. With poor design you end up having to go through the closet to get to the kitchen, or even worse the foundation may begin to crack.  Similarly, with poorly designed EHR workflows, you can end up with duplicate documentation, activities that take more time than they should, and workarounds or shortcuts that can lead to negative consequences. Set your healthcare organization up for success and create a solid foundation by making workflow mapping and redesign a priority.

Xerox is a sponsor of the Breakaway Thinking series of blog posts. The Breakaway Group is a leader in EHR and Health IT training.

Meaningful Use Hardship Exceptions Reopened

Posted on October 8, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

CMS has announced its intent to reopen the Meaningful Use Hardship Exceptions filing period and set the new deadline for MU hardship exceptions to November 30, 2014. With the new hardship exception extension, providers can now choose from a number of reasons why they were unable to attest in time. Here’s the details from the CMS announcement:

This reopened hardship exception application submission period is for eligible professionals and eligible hospitals that:
* Have been unable to fully implement 2014 Edition CEHRT due to delays in 2014 Edition
CEHRT availability; AND
* Eligible professionals who were unable to attest by October 1, 2014 and eligible hospitals that were unable to attest by July 1, 2014 using the flexibility options provided in the CMS 2014 CEHRT Flexibility Rule.

These are the only circumstances that will be considered for this reopened hardship exception
application submission period.

This is a big move since the meaningful use hardship exceptions deadline for hospitals was April 1, 2014 and July 1, 2014 for eligible professionals. I imagine there are many organizations that will benefit from this extension. Although, there are probably quite a few organizations that wish they’d known about this exception before now or that think the exceptions are too narrow (ie. they can’t benefit from them).

What are your thoughts on this extension?

5 Ways Patient Engagement Can Benefit Your Bottom Line

Posted on October 7, 2014 I Written By

The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff

Patient engagement is a popular topic with policy makers and patient advocates. They see the obvious benefits of an involved patient helping to improve their own health and eventually lower costs. Unfortunately, most doctors just see patient engagement as unreimbursed work. The majority of them can see the healthcare benefit of engaging the patient, but they have a much harder time seeing the financial benefits to them for doing so.

With that in mind, let’s take a look at some of the ways engaging your patient can benefit your bottom line:

Meaningful Use Requirements – This was the easy one. Meaningful Use stage 2 requires an organization to engage with at least 5% of their patient population. This is how serious the government is about patient engagement. The 5% requirement means that the $44k-$65k in EHR incentive money is tied to your ability to engage with patients. For those who aren’t interested in the EHR incentive money, you’ll still be subject to the 1-5% EHR Medicare penalties that are quickly approaching (start in 2015).

Get Paid – I’m sure that many doctors don’t think of this as patient engagement, but it’s a very important part of your engagement with the patient. There’s a growing trend towards high deductible plans where the patient is shouldering more of the financial burden for their care. Finding multiple ways where you can engage with the patient and collect their portion of the bill is going to become increasingly important. Many new patients don’t even check their snail mail regularly. This means you’re going to have to find new electronic methods for collecting payments (ie. engaging the patient electronically). We’ve seen significant success with the implementation of automated calls (IVR) and patient payment portals.

Drive New Patient Referrals – In some areas of the country this isn’t an issue, but many doctors live in an area where attracting patients is highly competitive. Since the start of medicine, one of the best ways to get new patients is through patient referrals. Providing great customer service is a fantastic way to increase the number of patient referrals you receive. (yes, patients are a type of customer). Superior patient engagement is one way to demonstrate great customer service. In fact, I believe many patients will start choosing their doctor based on the quality of engagement they get as patients.

Engage Pre-patients – How do you convert a visitor to your website into a patient? The simple answer is that you engage with them on your website (Side Note: your phone number on your website is not engagement). Many practices are afraid of engaging with patients on their website because they think that patients are trying to get a free consult without having to come into the practice. From my experience, this is a minor issue and is far surpassed by the number of new patients you can find on your website. When you engage the visitors to your website, you turn those who were on the fence about scheduling an appointment into actual appointments. Plus, much of this engagement can be done by your office staff. Think of it like a virtual telephone and answering machine for your office.

Increase Adherence – Many of you might be asking how increased patient adherence can benefit a practice’s bottom line. Let’s go back to the patient referral comments above. The best way to ensure someone provides your name as a referral to their friend is for you to help a patient get better. Ensuring adherence and health improvement is the ultimate customer service and a great way to create a true patient ambassador for your office.

ACOs and Value Based Reimbursement – While we’re still currently living in the fee for service world of healthcare, the powers that be are pushing towards value based reimbursement and Accountable Care Organizations (ACOs). As part of this shift, your reimbursement will be tied to how effectively and efficiently you care for your patient population. Engaging the patient in ways that are efficient and improve the quality of care you provide are going to be the bedrock of these initiatives. If you do not engage the patient in a thoughtful way, your future reimbursement will be dramatically less than you’re receiving today.

These are a few examples of why it pays to spend some time and effort engaging with the patient. I’m sure that many of you could add to the list in the comments. What value have you seen in your office from increasing your engagement with patients?

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

Confusing HIPAA Compliance With Security

Posted on October 2, 2014 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Most people  who read this publication know that while HIPAA compliance is necessary, it’s not sufficient to protect your data. Too many healthcare leaders, especially in hospitals, seem satisfied with the song and dance their cloud vendor gave them, or the business associate that promises on a stack of Bibles that it’s in compliance.

I was reminded of this just the other day when Reuters came out with some shocking statistics. One particularly discomforting stat it reported was the fact that medical data is now worth 10 times more than your credit card number on the black market (even if John has argued otherwise). Why? Well, among other things, because medical identity theft isn’t tracked well by providers and payers, which means that a stolen identity can last for months or years before it’s closed down.

Healthcare is not only lagging behind other industries in terms of its hardware and software infrastructure, but the extent to which its executives give a care as to how exposed they are to a breach. Security experts note that senior executives in hospitals see security as a tactical, not a strategic problem, and they don’t spend much time or money on it.

But this could be a deadly mistake. As Jeff Horne, vice president at cybersecurity firm Accuvant, noted to Reuters, “healthcare providers and hospitals are just some of the easiest networks to break into. When I’ve looked at hospitals, and when I’ve talked to other people inside of a breach, they are using very old legacy systems – Windows systems that are 10+ years old that have not seen a patch.”

As if that wasn’t enough, it’s been increasingly demonstrated that medical devices — from infusion pumps to MRIs — are also frighteningly vulnerable to cyber attacks. The vulnerabilities might not be found for months, and when they are, the hapless provider has to wait for the vendor to do the patching to stay in FDA compliance.

So far, even the biggest HIPAA breaches — notably the 4.5 million patient records stolen from hospital giant Community Health Systems — don’t seem to have generated much change. But the sad truth is that unless hospitals get their act together, focused senior executive attention on the issue, and spend enough money to fix the many vulnerabilities that exist, we’re likely to be at the forefront of a very ugly time indeed.

A Few Thoughts After AHIMA About the HIM Profession

Posted on September 30, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This year was my 4th year attending the AHIMA Convention. There was definitely a different vibe this year at AHIMA than has been at previous AHIMA Annual Convention. I still saw the humble and wonderful people that work in the HIM field. I also still saw a passion for the HIM work from many as well. However, there seemed to be an overall feeling from many that they were evaluating the future of HIM and what it means for healthcare, for their organization, and for them personally.

This shouldn’t really come as a surprise. Think about the evolution that’s been happening in the HIM world. First, they got broadsided by $36 billion of stimulus money that slapped EHR systems in their organizations which questioned HIM’s role in this new digital world. Then, last year they got smashed by a few lines in a bill which delayed ICD-10 another year. It’s fair to say that it’s been a tumultuous few years for the HIM profession as they consider their place in the healthcare ecosystem.

While a little bit battered and scarred, at AHIMA I still saw the same passion and love for the work these HIM professionals do. I might add, a work they do with very little recognition outside of places like AHIMA. In fact, when EHR systems started being put in place, I think that many organizations wondered if they’d need their HIM staff in the future. A number of years into the world of EHRs, I think it’s become abundantly clear in every organization that the HIM staff still have extremely important roles in an organization.

While EHR software has certainly changed the nature of the work an HIM professional does, there is still plenty of work that needs to be done. We’d all love for the EHR to automate our entire healthcare lives, but it’s just not going to happen. In fact, in many ways, EHR software complicates the work that’s done by HIM staff. Remember that great HIM modules, features, and functions don’t sell more EHR software (more on that in future posts). Sadly, the HIM functions are often an afterthought in EHR development. We’ll see if that catches up with the EHR vendors.

As I’ve dived deeper into the life and work of an HIM professional, I’ve seen how difficult and detailed the job really can be. Not to mention, the negative consequences an organization can experience if they don’t have their HIM house in order. Just think about a few of the top functions: Release of Information, Medical Coding, Security and Compliance. All of these can have a tremendous impact for good or bad on an organization.

What is clear to me is that the HIM professional has moved well beyond managing medical records. If done well, the HIM functions can play a really important part in any healthcare organization. The challenge that many HIM professionals face is adapting to this changing environment. I see a number of real stand out professionals that are doing phenomenal things in their organization and really have an important voice. However, I still see far too many who aren’t adapting and many who quite frankly don’t want to adapt. I think this will come back to bite them in the end.

The Future of Healthcare IT Publishing

Posted on September 26, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

During today’s #HITsm chat, Karen DeSalvo joined the chat and asked what healthcare IT will be like in 2024. Brian Eastwood, Senior Editor at, tweeted the following:

The topic was of interest to me as a health IT blogger myself. However, this was my response:

This of course led to Brian and I contributing to a series of possible 2024 Health IT Headlines we have to look forward to:

I’m pretty sure this wasn’t what Karen DeSalvo had in mind when she asked the question, but I thought it was fun to think about these possible headlines. Plus, I think there’s a fair amount we can learn from thinking about the future in this type of headline fashion. What do you think the healthcare IT headlines will say in 2024?

The Medication List Said, “Raised toilet seat daily”

Posted on September 25, 2014 I Written By

The following is a guest blog post by Lisa Pike, CEO of Versio.
With over a third of healthcare organizations switching to a new EHR in 2014, there is a lot of data movement going on. With the vast amount of effort it took to create that data, it’s a valuable asset to the organization. It can mean life or death; it can keep a hospital out of the courtroom; and it can mean the difference between a smooth-running organization and an operational nightmare.

But when that important data needs to be converted and moved to a new EHR, you realize just how complex it really is.

During a recent conversion of legacy data over to a new EHR, we came across this entry in the Medication List:  Raised toilet seat, daily.

Uh, come again??

How about this one?  “Dignity Plus XXL [adult diapers]; take one by mouth daily.”  What does the patient have, potty mouth?

Now, while we may snicker at the visual, it’s really no joke. These are actual entries encountered in source systems during clinical data migration projects. Some entries are comical; some are just odd; and some are downright frightening. But all of them are a conversion nightmare when you are migrating data.

Patient clinical data is unlike any other kind of data, for many reasons. It’s massive. It requires near-perfect accuracy. It’s also extremely complex, especially when you are not just migrating, but also converting from one system “language” to another.

Automated conversion is a common choice for healthcare organizations when moving data from legacy systems to newly adopted EHRs. It can be a great choice for some of the data, but not all. If your source says “hypertension, uncontrolled,” but your target system only has “uncontrolled hypertension,” that’s a simple enough inconsistency to overcome, but how would you predict every non-standard or incorrect entry you will encounter?

Here are some more actual examples. If you’re considering automated conversion, consider how your software would tangle up over these:

346.71D  Chm gr wo ara w nt wo st ???
levothyroxine 100 mg Should be mcg. Yikes!
Proventil Target system has 20 choices
NKDA (vomiting) NKDA= no known drug allergies.
Having no allergies causes vomiting?
Massage Therapy, take one by mouth twice weekly ???
Tylenol suppositories; take 1 by mouth daily Maybe not life-threatening, but certainly unpleasant
(Pelizaeus-Merzbacher disease)
Should have been PMDD
(premenstrual dysphoric disorder)
Allergy:  Reglan 5 mg Is patient allergic only to that dosage, or should this have been in the med list?
Confusing allergies and meds can be deadly.
Height 60 Centimeters or inches? Convert carefully!


These just scratch the surface of the myriad complexities, entry errors, and inconsistencies that exist in medical records across the industry. No matter how diligent your staff is, I guarantee your charts contain entries like these!

When an automated conversion program encounters data it can’t convert, it falls out as an “exception.” If the exception can’t be resolved, the data is simply left behind. Even with admirable effort, almost no one in the industry can capture more than 80% of the data. Some report as low as 50%.

How safe would you feel if your doctor didn’t know about 20% of your allergies? What if one of those left behind was the one that could kill you? What if a medication left behind was one you absolutely shouldn’t take with a new medication your doctor prescribed? Consider the woman whose aneurysm history was omitted during a conversion to a new EHR, so her specialist was unaware of it. She later died during a procedure when her aneurysm burst. I would say her family considered that data left behind pretty important, as did the treating physician, who could be found liable.

Liable, you say?

That’s right. The specialist could be found liable for the information in the legacy record because it was available….even if it was archived in an old EHR or paper chart.

You can begin to see the enormity of the problem and the potentially dangerous ramifications. Certainly every patient deserves an accurate record, and healthcare providers’ effectiveness, if not their very livelihood, depends on it. But maintaining the integrity of the data, especially during an EHR conversion, is no trivial task. Unfortunately, too many healthcare organizations underestimate it, and clearly it deserves more attention.

There is good news, however. With a well-planned conversion, using a system that combines robust technology with human expertise, it is possible to achieve 100% data capture with 99.8% accuracy. We’ve done it with well over a million patient chartsIt isn’t easy, but the results are worth it. Patients and doctors deserve no less.

Lisa Pike is the CEO of Versio, a healthcare technology company specializing in legacy data migration, with a proven track record of 100% data capture and 99.8% quality. We call it “No Data Left Behind.” For more information on Versio’s services or to schedule an introductory conversation, please visit us at or email

What Healthcare Must Plan for in Q4

Posted on September 19, 2014 I Written By

The following is a guest blog post by Ben Quirk, CEO of Quirk Healthcare Solutions.
Ben Quirk
In some ways, 2014 turned out to be not quite as cataclysmic. The early announcement of delaying the adoption of ICD-10 and the more recent announcement to allow hospitals/CAHs and Eligible Professionals participating in CMS’ Meaningful Use programs to attest using their existing Certified Electronic Health Record Technology (CEHRT) took the pressure off healthcare providers scrambling to upgrade their CEHRT to a version that was both ICD-10 and MU-compliant. However, this is only a temporary reprieve through the end of 2014 and there are other priorities that must be addressed before the year ends.

Navigating the ever-evolving healthcare environment will seem much less daunting if you focus on these four areas:

  • Meaningful Use
  • Value-Based Payment Modifiers
  • Transparency
  • Open Enrollment for ACA

Meaningful Use (MU)

If you were not able to upgrade to the 2014 Edition EHR, you will still be able to attest for MU using 2013 criteria. This provides reprieve from the 2014 criteria that requires the implementation of and patient enrollment in a patient portal.

In order to be MU-ready, your organization must proactively:

  • Determine your strategy based on the final rule. Gather data and be prepared to attest for MU by the deadline for the MU program you participate in..
  • Create an audit binder which should include screenshots of required EHR configuration during the reporting period. Should you get an audit 2 years from now, you can refer to this binder for accurate information.
  • Prepare a statement citing why you should be allowed to opt out of those MU measures that you think do not pertain to your practice. Auditors will ask for this on any audit preformed.

All organizations should be prepared to start collecting data for MU 2 by January 1, 2015. This includes having a strategy around the implementation of a patient portal and patient enrollment, sharing data amongst community and other healthcare providers, and radiology interfaces.

Value-Based Payment Modifier

The current Value Based Payment Modifier for providers who serve Medicare beneficiaries is a descendent of the Physician Quality Reporting System (PQRS). It is a way to keep the ACA cost-neutral, but there are some important things you need to know about this newer system. Value-Based Payment Modifier takes claims, Meaningful Use, and physician quality data and rates the quality of care you provide against your peers. Consequently,

  • When you report your Clinical Quality Measures or any clinical data to CMS, make sure your thresholds demonstrate that your practice is providing high quality care.
  • If your practice suffered from vendor problems with data accuracy in the past, this should be fixed.


Transparency is something all providers should be aware of. Although available only in a few markets right now, all patients will soon be able to look up information about physicians before deciding where they would like to have their medical procedures done. For instance, if a patient decides to have an ACL repair, s/he can go online to compare exact costs and quality measures (based on the Patient Quality Reporting System) for ACL repair. Practices need to be aware that their prices and quality are being reported publicly. The implications go beyond losing reimbursement. You can actually be delisted from an insurance network. To ensure that your practice remains a viable option for patients:

  • Market your own practice and post your own prices.
  • Make sure you are reporting good quality data.
  • Use sources such as MGMA or OPTUM to see what providers in your area are charging and how you compare.
  • Determine how your reimbursement ranks vs. your competitors on the Medicare website and ensure data accuracy.

Open Enrollment for the ACA

November 15 marks the beginning of the second Open Enrollment period for the Affordable Care Act and there is no indication that this time around will be any easier than the first. Patients will be choosing plans, dealing with things very unfamiliar, and perhaps unaffordable, to them, like deductibles. This directly impacts clinics and the bottom line, especially with those patients who cannot pay their share of the costs. Last year, patients became the number one payor for many practices, even more than insurance companies, because so much revenue came from deductibles. That all resets January 1, but there are things you can do to avoid a possibly painful Q1 of 2015:

  • Check and confirm all patients’ eligibility, what plan they are on, and what their deductible is prior to their scheduled appointment, preferably through an automatic batch eligibility service. Keep this information in the practice management system.
  • Notify patients about their deductibles before they come into the clinic, and make sure to collect payments upfront, or keep a card on file.

The healthcare industry as we knew it for the past many years has ceased to exist. As we move into a new era of integrated delivery systems and a greater emphasis on value-based rather than volume-based reimbursements, the industry is going to remain in a state of flux before it stabilizes once again. The only way organizations are going to survive in this shifting landscape is by anticipating and planning for the next change so that they can stay ahead of the curve. The more an organization knows, the better it can be prepared to confront any potentially negative impact of the ever-evolving nature of the industry.

About Ben Quirk
Ben Quirk is CEO of Quirk Healthcare Solutions, a consulting firm specializing in EHR strategic management, workflow optimization, systems development, and training. The company’s clients have enjoyed remarkable success, including award of the Medicare Advantage 5-star rating. Quirk Healthcare presents a weekly webinar series, Insights, to inform clients and the general public about government programs and industry trends. Mr. Quirk is also Executive Director of the Quirk Healthcare Foundation, a learning institution which fosters innovation in the healthcare industry.