Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

A reader posed the following question: What happens if a physician receives a Medicaid EHR incentive in 2011, no longer meets the 30% eligibility threshold for Medicaid in 2012 and therefore elects not to apply for any incentive that year, and then has to switch to the Medicare program in 2013 because his Medicaid volume is still too low to qualify under Medicaid? Below is a follow-up to a prior post, (“Switching Between Medicare and Medicaid Incentive Programs”), that provides the additional information needed to not only answer this particular question, but also to evaluate the financial impact of other scenarios in which a provider might skip years and/or switch between programs. 

Here are the rules regarding switching programs and skipping years:

• An EP can switch between programs only once after receiving his first incentive payment, and the switch must occur in 2014 or earlier.
• When an EP switches programs, he is “placed in the payment year he would have been in had he begun in—and remained in—the program to which he has switched.”
• Medicare and Medicaid treat skipping years differently. Medicare incentives require that payment years be consecutive—so while an EP can skip a year, if he does, he forfeits that year’s incentive permanently. Medicaid incentive payments, on the other hand, can be non-consecutive with no adverse impact on total available revenue.
• The last year that payments will be available also differs between the two programs. Under Medicare, no payments will be made after 2016, whereas EPs have until 2021 to earn incentives under Medicaid.
• Although an EP who switches to or from the Medicare program could—under certain circumstances—earn more than the total Medicare incentives ($44,000), in no cases would any EP be paid more than the maximum available under Medicaid ($63,750). 

To get back to the physician in the reader’s question, when he switches to the Medicare program after skipping 2012, 2013 would be considered (and paid as) his third payment year. 

Confused? To analyze the financial implications of switching programs and/or skipping a year under scenarios that might apply to your practice, make a chart and do the math—taking into account the above rules and the schedules of annual incentives.

I’m sure many of you are recovering from the Super Bowl right now. I got exactly what I wanted from the Super Bowl: a great game. I didn’t care too much either way, but I am glad that I predicted the Giants to be the winners. Too bad I’m not a betting man. Although, I guess that’s the trick with betting….but I digress.

Time for my regular weekend round up of interesting things happening in the healthcare IT and EMR twittersphere. We’ve got some really interesting tweets this week. Here we go.

@NateOsit We also have a webinar of @eCollab12 for those that wont’ be able to make it to #HIMSS12.ecollab12.eventbrite.com #hitsm

— Leonard Kish (@leonardkish) February 3, 2012

When I created and posted my list of HIMSS 12 sessions, they hadn’t created the agenda for the eCollaboration Forum at HIMSS and so I couldn’t add any sessions. However, the eCollaboration Forum at HIMSS 12 agenda is up now, so check it out. I know there are a number of sessions I’m going to add from the forum. I also love that they have the online option linked in this tweet for those not attending HIMSS 2012.

Yes, stage 2 #meaningfuluse NPRM will be out before #HIMSS12. meaningfulhitnews.com/2012/01/30/yes… #healthIT #ONC #CMS #hitpol #EHR #EMR

— Neil Versel (@nversel) January 31, 2012

This is really important news. I think a lot of us are REALLY interested to see the final meaningful use stage 2 details. Good find by Neil Versel.

Speaking doctor-to-doctor(s) using healthcare social media bit.ly/wiqbyu #hcsm #hcsmeu

— H2Online (@H2Ohu) January 30, 2012

I’m sure we’re going to continue seeing the trend of more and more doctors gleaning value from engaging in social media. At a minimum doctors are going to start finding more and more new patients using social media including things like physician blogging. A well done practice website and social media effort is going to be really valuable for the doctor of the future.

3 reasons why you should start a blog for your hospital bit.ly/ypCE78 #hcsm #blogging

— Mark Ragan (@MarkRaganCEO) January 30, 2012

Yes, blogging will also help hospitals in a number of ways too. Social media can benefit hospitals, doctors, practices, etc.

@DonRosenthal Tablets are for content consumption. PCs are for content creation. Much more intellectual flexibility w/ PCs. #HITsm

— Erica V. Olenski (@TheGr8Chalupa) February 3, 2012

I was fascinated by this tweet. First because I wonder what changes will make tablets more than just great for content consumption. Second, the idea of PCs being more intellectually flexible.

RT @patientslikeme: “my healthcare data is not nearly as portable/accessible as my financial data.” @jeff_cole #hcsm

— Jacqueline Thong (@jacthong) January 30, 2012

I know there are reasons why financial data is more portable and accessible than healthcare data, but it still irks me that we haven’t overcome those reasons…yet!

In a previous Meaningful Use Monday we wrote about a bunch of the Meaningful Use 2011 statistics that were put out by ONC and CMS. I know that my readers love statistics and information about Meaningful Use. Carl Bergman sent me a PDF file that contained some really interesting data on Meaningful Use stage 1 in 2011. The first pages we basically covered in the previous post, but starting on about page 10 or so there are some more detailed numbers.

Take a look at let us know which numbers you find interesting and/or unique.

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I’m really excited to announce the 3rd annual New Media Meetup at HIMSS 2012. Last year’s event had an amazing turnout in Orlando and I expect this year’s will be even better with a whole bunch of interesting new and old faces. It’s quite frankly my favorite part of HIMSS thanks to the amazing people who are there.

Everyone is welcome at the event. Maybe you participate in New Media (Blogger, Tweeter, LinkedIn, Facebook, etc) or maybe you just enjoy consuming other people’s media (like this blog) or maybe you’re interested in using New Media for yourself or your company. Everyone is welcome to attend and network with others interested in New Media. I’m excited this year to welcome the #HITsm and #hcsm crowd that will be out in full force I’m sure.

If that isn’t enough reason to attend, I’m really happy to have teamed up with simplifyMD to sponsor the New Media Meetup at HIMSS Las Vegas. The event will be on Wednesday 2/22 7:00-9:00 PM at the awesome BB King’s Blues Club in the Mirage Hotel (A short walk across the street from the Venetian/Sands). That’s right: an open bar, Live Music with a dance floor, and amazing people.

REGISTER NOW!!

Please register for the event so we know how many to expect. I expect we’ll max out registrations for the event like we did last year, so register now before it’s too late.

Be sure to tell all your Blogger, Twitter and other new media friends about the event so we have the best and brightest in the healthcare IT social media world at the event.

About Our Sponsors

simplifyMD – Founded in 2006 and headquartered in Atlanta, thousands of end-users benefit from simplifyMD every day as they manage millions of electronic health records for physicians in 27 specialties and on two continents. simplifyMD was created specifically to lower operating costs, increase revenue, and provide relief to overworked physicians and administrators. Offering a cloud-optimized SaaS solution for one low monthly price, that costs less than traditional paper folders, makes simplifyMD’s EHR software as easy to buy and implement as it is to learn and use. At simplifyMD we believe the EHR experience does not have to be so complicated. All EHR companies promise efficiency, simplifyMD guarantees it.

HealthcareScene.com – The premiere healthcare IT and EMR network of websites. HealthcareScene.com consists of 14 different EMR, EHR and Healthcare IT websites having generated over 7+ million pageviews and includes over 3500 article and 9000 comments. HealthcareScene.com works to promote the interesting independent voices in healthcare. HealthcareScene.com also recently launched a content creation division for third parties.

Influential Networks – Influential Networks is one of the largest networks of healthcare IT influencers combined with a premium healthcare IT ad network. Through the Influential Network, we help both marketers and publishers reach their goals within this powerful niche market. Influential Networks goal is to connect influencers with publishers beyond just advertising.

If you have any questions about the event, feel free to drop us a line on our Contact Us page. See you in Las Vegas!

One of the more interesting dynamics in the EMR and EHR world has to do with large versus small EHR companies. I guess we’ve always loved a big versus small story ever since David slew the Giant Goliath. Plus, there’s something American that causes most of us to really root for the underdog. I don’t know what it is, but unless my team is playing I’m most often hoping that the underdog spoils the party and does something surprising. Maybe this is why so many of us love to pit the big EHR vendors against the small EHR vendors.

Personally I don’t have any particular preference for or against larger or small EHR vendors. I care more about choosing the right EHR vendor for the right situation. In some cases those are small EHR vendors and in some cases those are large EHR vendors. I only discriminate against EHR vendors who don’t perform. Many of those that don’t perform I call Jabba the Hutt EHRs. If you haven’t read my Jabba the Hutt EHR posts, you should.

Although, what prompted this post was a comment I read recently from a doctor who uses a large EHR vendor. I won’t say which EHR or who made this comment since it doesn’t matter to learn from the comment. They basically made this suggestion:I recommended a large EHR so that it can connect everything. Then he said that the large EHR vendor decreased productivity.

Certainly I realize this is only one person discussing why doctors should go with a large EHR vendor, but if I’m a large EHR vendor I’d be really upset if this is my message. And while this is one example, I’ve certainly heard it other times before.

Think about this message from a physician’s perspective. I can either go with an EHR product that decreases my productivity (Translation: I make less money) or with an EHR product that can connect everything (Translation: That’s nice, but does it save me time or make me more money?)

All the connections in the world are great, but if you hurt a clinical processes business in the process then that’s going to be a real problem. I’m a huge EHR software advocate. I think every doctor should use EHR. However, if EHR vendors continue to do EHR implementations that have a long term negative impact on EHR productivity, then physicians will continue to resist EHR software in their offices.

The good news is that I’m seeing more and more EHR vendors focused on maintaining and improving the productivity of an office during and after an EHR implementation. I hope that trend continues and that all EHR vendors become fanatical at maximizing the efficiency of a practice during and post EHR implementation.

In a number of my online conversations we’ve been having really in depth discussions about the idea of whether it’s better for a hospital HIS system is better as an All-In-One system or whether Best of Breed healthcare IT systems are better. Much of this discussion has been sparked from posts done on my Hospital EMR and EHR blog. So, if you’re in the hospital space and are not following that site, you should. You can even sign up for the Hospital EMR and EHR list if you’d like. Anne Zieger writes most of the content there and she doesn’t mince words.

In all of these discussions, something became really clear to me:

The best reason to use Best of Breed healthcare IT systems is for usability.

The best reason to use an All-in-One system is for interoperability.

Some people may see this as too simplistic, but I loved a quote I read recently that said you don’t truly understand something until you can describe it in a simple form. I actually heard Bill Belichick do this talking about what he looks for in receivers for his Football team (Anyone excited for Super Bowl Sunday?). He said he likes a receiver that can Get Open and Catches the Ball. Seems far too simplistic, but it’s so simplistic it’s genius.

I think the same could be said for evaluating hospital IT systems:

The thing I like most in a healthcare IT system is one that’s Usable and Integrates Well.

If you are on of the 355 Eligible Providers who unsuccessfully attested to MU last year, CMS now offers an appeals process for both the Medicare and Medicaid programs. Here’s the section on appeals for EHR Incentive programs:

Starting December 1, 2011, CMS is accepting appeals for eligible professionals and eligible hospitals.

For general questions and for information on how to file an appeal, eligible professionals (EPs), eligible hospitals, critical access hospitals, Medicare Advantage Organizations, and Medicaid eligible hospitals may contact OCSQ’s designated appeal support contractor via the toll free number between 9 a.m. and 5 p.m. EST, Monday through Friday or via email.

1. Toll-free number: 855-796-1515
2. Email: OCSQAppeals@provider-resources.com

The Centers for Medicare & Medicaid Services (CMS), Office of Clinical Standards and Quality (OCSQ) is providing guidance on how to file an appeal.

If you click through to the How to File an Appeal link, it says that the final rule provides guidance and requirements for a Medicaid appeals process, but does not provide an appeals process for the Medicare EHR Incentive program. Although it also says that “CMS is currently implementing an appeals process for the EHR Incentive Program.”

It does also say that Provider Resources, Inc. (PRI) located in Erie, Pennsylvania was awarded the contract to handle the appeals process with the Office of Clinical Standards and Quality (OCSQ) overseeing the EHR incentive appeals process. Otherwise, it’s still pretty vague on the exact details of the appeals process other than the contact info.

I’ve read that beginning in February, appeal decisions will be posted on CMS’s Website under the Office of Clinical Standards and Quality. I hope that there’s some really good transparency in these postings so that those attesting to meaningful use in the future will be able to learn from people’s past mistakes.

If you’re someone that was denied and is going through the appeals process, I’d be interested to hear about your experience so we can share it with others that will need to do the same.

We’re back with our weekend round up of interesting tweets from the Twittersphere. We’ve got some really interesting ones to consider this week. So, much is happening in healthcare IT. Hopefully I can provide a good insight to some of the trends that are most interesting. No doubt this will be a challenge as we head into what is one of the most busy healthcare IT news cycles of the year around HIMSS.

Now, on to the various EHR and Healthcare IT tweets:

Just What the Doctor Ordered: Mobile Access to Your Kaiser EHR ow.ly/8KwkP – check out my latest blog for @ehrandhit

— Jennifer Dennard (@SmyrnaGirl) January 30, 2012

Kaiser Permanente just made 9 Million EHR records available on line to the patients. That’s definitely worth talking about. Go read about it in Jennifer’s post.

This tweet just made me laugh (although, if you’re experiencing it, it’s not that funny):

What’s the billing code for EHR Anxiety? ow.ly/8KAWx #EHR #HCSM

— Alicia C. Staley (@stales) January 30, 2012

I think they probably need a DSM-IV code.

What if the patient was the repository of their own data – perhapsQcode on my phone to my EHR? plug into me not my data #hitsm

— Sherry Reynolds (@Cascadia) January 27, 2012

I know there are a number of companies working on this. The problem isn’t the technology to get the Qcode to access your patient record. It’s aggregating your patient record in some place so that it’s accessible. That’s going to take a long time (if ever) to get it all connected.

This is a great idea! #EHR Accessibility Challenge scr.bi/wTOetz #cisummit

— Brian Ahier (@ahier) January 26, 2012

I’m fascinated by this idea as well. I hope some companies will take it really seriously. The interesting thing is that often by making software accessible, you also learn a lot about how you can simplify the software.

EHR Design Talk with Dr. Rick 1/23/12: Computer-Centered versus User-Centered Design Within the next few years, … bit.ly/yPqDOw

— histalk (@histalk) January 24, 2012

Dr. Rick does a great job starting the conversation around EHR usability. I can’t imagine the effort he put in just to create the first post. Of course, it is a first offering, but I’m really glad that he’s started a deeper discussion around EHR usability. My only disappointment is that he isn’t posting them on one of my sites instead of HIStalk. Regardless, by the looks of the discussion in that post it’s going to drive some really interesting conversation that will hopefully result in improved EHR design.

Yesterday I had the opportunity to talk with the people from GE who briefed me that GE is in the process of shutting down their GE Centricity Advance product line. This was pretty big news to me since I remember just last year at HIMSS meeting with GE and hearing that for the small practice (I believe 1-10 docs) GE Centricity Advance was where they were putting all their effort. You could see the energy they had behind it. In fact, their iPad EHR app was built on top of the GE Centricity Advance solution (which is now being moved to their other EHR product lines).

You might remember that the GE Centricity Advance solution was actually created out of the purchase of MedPlexus in March 2010. At the time, MedPlexus had 100 employees out of California with the development team out of India. At the time of purchase it seemed GE’s acquisition would provide a SaaS based EHR option to the independent physician market. Plus, MedPlexus (which became GE Centricity Advance) also provided an integrated Practice Management System with the EHR.

The GE Centricity Advance website is already forwarding to the Centricity Practice Solution website and a letter was sent out to all Centricity Advance customers informing them that the product line was ceasing operation. I’ve asked for a copy of that letter and if I get it, I’ll add it to this post (or if you’re a customer that received it and doesn’t mind sharing we’d welcome it).

I was told that GE is offering Centricty Advance users a free transfer to their Centricity Practice Solution EHR software. From what they told me it seems this will include data migration, training on the new system and a license for Centricity Practice Solution. Of course, Centricity Advance was paid on a subscription model so they’ll have to continue paying the monthly fee. As with most data migrations, I don’t think we’ll know how good GE is at migrating the data from GE Centricity Advance to Centricity Practice Solution until they start to do them.

Since both Centricity Advance and Centricity Practice Solution have ONC-ATCB complete EHR certification, there shouldn’t be any problems for those that transfer to Centricity Practice Solution when it comes to EHR stimulus money. Those not wanting to move to the Centricity Practice Solution will have this as part of their decision on what to do once Centricity Advance is no longer supported. I expect there will be many in this situation since while Centricity Practice Solution is available through GE’s partners as a “SaaS” offering, I think many will want to find a true from the ground up web based SaaS EHR offering.

I asked how many providers would be effected by the end of the Centricity Advance product line, but it’s GE’s policy to not comment on those numbers.

Where does this leave GE Centricity EMR software?
GE Healthcare IT still does a couple billion dollars of business and still has three EMR software offerings:
*Centricity Practice Solution – The replacement for Centricity Advance and will be GE’s EMR offering for the 1-100 provider practices.
*Centricity EMR – Still ambulatory EMR, but for the 100+ provider practices.
*Centricity Enterprise – Acute care EMR

I’m sure that many will wonder how good the Centricity Practice Solution will do in the small practice arena. Will this basically mean that GE is no longer a player in the small 1-10 provider practices? It’s hard to say for sure, but I’ll be interested to see how the Centricity Practice Solution EHR does in this market. There must have been a reason they purchased what became Centricity Advance instead of going with Centricity Practice Solution in the first place.

On the other hand, I could see people making the argument that this is a sound strategy by GE since movements like accountable care organizations (ACO’s) and related initiatives are putting the small practice in jeopardy. We know that many hospital systems are purchasing up group practices as they prepare to become an ACO among other reasons. While we still have many small group practices, it’s worth considering how many of them will survive the changing landscape. If not many survive, then this strategy by GE could end well for them. Although, I personally believe that practice consolidation is cyclical and so I’m not ready to announce the death of small group practices yet.

Another trend that might make this a good decision on GE’s part is what I call the Smart EHR. Our current phase of EHR adoption is basically converting paper to electronic. Once doctors start requiring EHR software to do things far more advanced (see Artificial Intelligence and Genomics EHR), it will require a new kind of EHR. Maybe Centricity Advance wasn’t prepared to make this shift. We’ll see if GE’s other EHR software is ready for it.

Many have argued that EHR consolidation is inevitable. I guess I shouldn’t be surprised that part of that EHR consolidation is happening within the same EHR company. I’m sure there are more on the way as we see which EHR companies survive the meaningful use winter and come out on the other side and which EHR companies close up shop.

Update: I asked GE for some more clarification on when GE Centricity Advance would be sunset and which data they’ll be migrating as part of the data migration process. Here are their answers:
Sunset Period: We have announced that we will cease operations of Centricity Advance on June 30, 2012. The data will be available in read-only mode until December 31, 2012.

Data Migration: We are working with our partners and customers to figure out the best way to migrate data. We have told customers that we will migrate the following data:
a. Patient Demographics, Patient Insurance data, Fee Schedules, Appointments
b. Patient Summary
c. Patient chart
We will migrate all clinical data. We are working with our partners to determine which financial information should be automatically migrated.

Last month CareCloud announced a new real-time analytics dashboard to help doctor streamline revenue cycle automation. The core of their product is what they call CareCloud Analytics. As I think about the announcement, I wondered if it was really a big deal or not and why we hadn’t seen more of this in the various practice management systems and EHR software on the market today.

Is Data Analytics important in Healthcare?
I think this type of information is a big deal. Information is power and this is never more true than in healthcare. The press release does a great job of describing how real-time analytics and dashboards provide information which provides transparency and accountability to a practice. One quote from the article says, “The practice can now manage the productivity of the office staff, monitor in real time the productivity of billers, and gain transparency into the business side of operations to help form better decisions through data, instead of intuition.”

I’m a huge fan of analytics in my business. I call myself a stats addict. I have 2-3 stats programs running on my websites at all times. I get stats from my ad server, from Google’s ad server, and from every other stats engine I can find that has reliable data. Much of my success with my websites is because of my passion for knowing what’s happening with my websites. To me, Data is power! The same can be said for a practice. Data is the power to make important decisions that are needed for the success of your practice.

Why don’t more EHR and PMS vendors provide these analytics?
I’m sure there are a number of reasons why we don’t see real time analytics happening very often in the small practices. Hospitals are a bit different. There are whole companies devoted to just providing these types of services to hospitals that can pay for a full scale data warehouse environment to provide this type of data. A hospital that doesn’t do this type of data mining is missing out as well, but they have a number of options. Although, I don’t think many hospital HIS vendors offer this info by default.

The key reason I think real-time analytics and customizable dashboards are missing in the small practice environment has to do with doctors demand (or lack thereof) for such a feature. This will surprise some, but most will agree that the majority of doctors don’t care much for the business side of the practice. Sure, they care that the business side of the practice effects how much money they take home at the end of the day, but a large portion of doctors would love their lives a lot more if they didn’t have anything to do with the business of a practice. Yes, I know there are exceptions to this, but most doctors want to practice medicine not business.

With this as background, if you ask most doctors what they want from their EHR and Practice Management software, they’ll start to list off all of the clinical and workflow needs that they have. Very few of them will even venture into the business requests like real time analytics. Plus, even if they did venture into the business side of things, would they know how to request such a feature?

EHR and Practice Management Vendors have to show them why it matters to have these real time analytics. It reminds me of the famous quote attributed to Henry Ford. “If I had asked people what they wanted, they would have said faster horses.” This can often be taken too far, but I think it applies well when it comes to things like real-time analytics of a practice.

One other reason that a number of companies are missing the analytics and its relationship with revenue cycle management is that they’re too focused on EHR. Many just consider the PMS a standard thing that everyone has already and that there’s no room to innovate. Last I checked meaningful use didn’t have any practice management elements and that’s taken up at least one development cycle for most companies. Too many doctors later dismay, the EHR selection process often puts the practice management side of the puzzle on the backseat. This is a mistake that many practices are paying for today.

As one PR rep for a major EHR company said to me, “Revenue Cycle Management isn’t sexy.” Although, she said this directly after telling me how beneficial it was to their bottom line.