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Study: Health IT Costs $32K Per Doctor Each Year

Posted on September 9, 2016 I Written By

Anne Zieger 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.

A new study by the Medical Group Management Association has concluded that that physician-owned multispecialty practices spent roughly $32,500 on health IT last year for each full-time doctor. This number has climbed dramatically over the past seven years, the group’s research finds.

To conduct the study, the MGMA surveyed more than 3,100 physician practices across the U.S. The expense number they generated includes equipment, staff, maintenance and other related costs, according to a press release issued by the group.

The cost of supporting physicians with IT services has climbed, in part, due to rising IT staffing expenses, which shot up 47% between 2009 and 2015. The current cost per physician for health IT support went up 40% during the same interval. The biggest jump in HIT costs for supporting physicians took place between 2010 and 2011, the period during which the HITECH Act was implemented.

Practices are also seeing lower levels of financial incentives to adopt EHRs as Meaningful Use is phased out. While changes under MACRA/MIPS could benefit practices, they aren’t likely to reward physicians directly for investments in health IT.

As MGMA sees it, this is bad news, particularly given that practices still have to keep investing in such infrastructure: “We remain concerned that far too much of a practice’s IT investment is tied directly to complying with the ever-increasing number of federal requirements, rather than to providing patient care,” the group said in a prepared statement. “Unless we see significant changes in the final rule, practice IT costs will continue to rise without a corresponding improvement in the care delivery process.”

But the MGMA’s own analysis offers at least a glimmer of hope that these investments weren’t in vain. For example, while it argues that growing investments in technologies haven’t resulted in greater administrative efficiencies (or better care) for practices, it also notes that more than 50% of responders to a recent MGMA Stat poll reported that their patients could request or make appointments via their practice’s patient portal.

While there doesn’t seem to be any hard and fast evidence that portals improve patient care across the board, studies have emerged to suggest that portals support better outcomes, in areas such as medication adherence. (A Kaiser Permanente study from a couple of years ago, comparing statin adherence for those who chose online refills as their only method of getting the med with those who didn’t, found that those getting refills online saw nonadherence drop 6%.)

Just as importantly – in my view at least – I frequently hear accounts of individual practices which saw the volume of incoming calls drop dramatically. While that may not correlate directly to better patient care, it can’t hurt when patients are engaged enough to manage the petty details of their care on their own. Also, if the volume of phone requests for administrative support falls enough, a practice may be able to cut back on clerical staff and put the money towards say, a nurse case manager for coordination.

I’m not suggesting that every health IT investment practices have made will turn to fulfill its promise. EHRs, in particular, are difficult to look at as a whole and classify as a success across the board. I am, however, arguing that the MGMA has more reason for optimism than its leaders would publicly admit.

E-Patient Update: Using Digital Health For Collaborative Medication Management

Posted on June 1, 2016 I Written By

Anne Zieger 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.

Recently, I had a medical visit which brought home the gap between how doctors and patients approach to medications. While the physician and his staff seemed focused on updating a checklist of meds, I wanted med education and a chance to ask in-depth self-management questions. And though digital health tools and services could help me achieve these goals, they didn’t seem to be on the medical group’s radar.

At this visit, as I waited to see the doctor, a nurse entered with a laptop on a cart. Consulting her screen, she read off my medication list and item by item, asked me to confirm whether I took the given medication. Then, she asked me to supply the name and dosage of any drugs that weren’t included on the list. Given that I have a few chronic conditions, and take as many as a dozen meds a day, this was an awkward exercise. But I complied as best I could. When a physician saw me later, we discussed only the medication he planned to add to the mix.

While I felt quite comfortable with both the nurse and doctor, I wasn’t satisfied with the way the medication list update was handled. At best, the process was clumsy, and at worst, it might have passed over important information on drug history, interactions and compliance. Also, at least for me, discussing medications was difficult without being able to see the list.

But at least in theory, digital health technology could go a long way toward addressing these issues. For example:

  • If one is available, the practice could use a medication management app which syncs with the EMR it uses. That way, clinicians could see my updates and ask questions as appropriate.
  • Alternatively, the patient should have the opportunity to review their medication list while waiting to be seen, perhaps by using a specialized patient login for an EMR portal. This could be done using a laptop or tablet on a cart similar to what clinicians use.
  • When reviewing their medication list, patients could select medications about which they have questions, delete medications they no longer take and enter meds they’ve started since their last visit.
  • At least for complex cases, patients should have an opportunity to do a telehealth consult with a pharmacist if requested. This would be especially helpful prior to adding new drugs to a patient’s regimen. (I don’t know if such services exist but my interest in them stands.)

To me, using digital health options to help patients manage their meds makes tremendous sense. Now that such tools are available, physicians can loop patients into the med management discussion without having to spend a lot of extra time or money. What’s more, collaboration helps patients manage their own care more effectively over the long term, which will be critical under value-based care. But it may not be easy to convince them that this is a good idea.

Unfortunately, many physicians see sharing any form of patient data as a loss of control. After all, in the past a chart was for doctors, not patients, and in my experience, that dynamic has carried over into the digital world. I have struggled against this — in part by simply asking to look at the EMR screen — but my sense is that many clinicians are afraid I’ll see something untoward, misinterpret a data point or engage in some other form of mischief.

Still, I have vowed to take better control of my medications, and I’m going to ask every physician that treats me to consider digital med management tools. I need them to know that this is what I need. Let’s see if I get anywhere!

This Time, It’s Personal: Virus Hits My Local Hospital

Posted on March 30, 2016 I Written By

Anne Zieger 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.

In about two weeks, I am scheduled to have a cardiac ablation to address a long-standing arrhythmia. I was feeling pretty good about this — after all, the procedure is safe at my age and is known to have a very high success rate — until I scanned my Twitter feed yesterday.

It was then that I found out that what was probably a ransomware virus had forced a medical data shutdown at Washington, D.C.-based MedStar Health. And while the community hospital where my procedure will be done is not part of the MedStar network, the cardiac electrophysiologist who will perform the ablation is affiliated with the chain.

During my pre-procedure visit with the doctor, a very pleasant guy who made me feel very safe, we devolved to talking shop about EMR issues after the clinical discussion was over. At the time he shared that his practice ran on GE Centricity which, he understandably complained, was not interoperable with the Epic system at one community chain, MedStar’s enterprise system or even the imaging platforms he uses. Under those circumstances, it’s hard to imagine that my data was affected by this breach. But as you can imagine, I still wonder what’s up.

While there’s been no official public statement saying this virus was part of a ransomware attack, some form of virus has definitely wreaked havoc at MedStar, according to a report by the Washington Post. (As a side note, it’s worth pointing out that if this is a ransomware attack, health system officials have done an admirable job of keeping the amount demanded for data return out of the press. However, some users have commented about ransomware on their individual computers.)

As the news report notes, MedStar has soldiered on in the face of the attack, keeping all of its clinical facilities open. However, a hospital spokesperson told the newspaper that the chain has decided to take down all system interfaces to prevent the spread of the virus. And as has happened with other hospital ransomware incursions, staffers have had to revert to using paper-based records.

And here’s where it might affect me personally. Even though my procedure is being done at a non-MedStar hospital, it’s possible that the virus driven delay in appointments and surgeries will affect my doctor, which could of course affect me.

Meanwhile, imagine how the employees at MedStar facilities feel: “Even the lowest-level staff can’t communicate with anyone. You can’t schedule patients, you can’t access records, you can’t do anything,” an anonymous staffer told the Post. Even if such a breach had little impact on patients, it’s obviously bad for employee morale. And that can’t be good for me either.

Again, it’s possible I’m in the clear, but the fact that the FUD surrounding this episode affects even a trained observer like myself plays right into the virus makers’ hands. Now, so far I haven’t dignified the attack by calling the doctor’s office to ask how it will affect me, but if I keep reading about problems with MedStar systems I’ll have to follow up soon.

Worse, when I’m being anesthetized for the procedure next month, I know I’ll be wondering when the next virus will hit.

Doctors Expected To Get “Meaningful Choices” From Patients On HIE Data Use

Posted on October 19, 2012 I Written By

Anne Zieger 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.

Making sure the clinical data flowing through HIEs is seen only by those patients designate is a tricky problem.  But according to the ONC, it’s a problem doctors need to take on and manage, according to recent guidance from the organization.

ONC’s logic is as follows:

As key agents of trust for patients, providers are responsible for maintaining the privacy and security of their patients’ health information. In turn, patients should not be surprised about or harmed by their provider’s collections, uses, or disclosures of their health information. 

In other words, patients should be given a “meaningful choice” as to how information is shared, rather than simply signing broad treatment-related disclosures.

And as ONC sees it, the treating professional is responsible for educating patients enough to give them meaningful awareness of their options, including how information will be shared and with whom, as well as obtaining and tracking the patient’s choice.

This strikes me as a pretty ambitious expectation to have of doctors, who in most cases need to do little to explain information sharing to patients. Educating them on the broad range of places data could go, under which circumstances, and the extent to which patients can opt in or out of such sharing, strikes me as a very large task.

I’m not saying that I think ONC’s recommendation is an unwise one.  In most cases, the doctor — who’s most likely to be the treating professional — is really the only person who’s in a position to do this kind of education.  Not only is the doctor the person the patient trusts, they’re also in a position to review how well patients have understood on an ongoing basis.

All that being said, it’s still a pretty complex lesson to teach. I hope someone, perhaps ONC itself, develops online self-education for patients which a doctor can simply offer during the visit.  Otherwise, I think the “meaningful choice” concept will be hard to pull off.

A Smart Approach To Medicine And Social Media

Posted on August 29, 2012 I Written By

Anne Zieger 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.

It’s always a pleasure to touch base with the thoughtful blog  (33 Charts) written by pediatric gastroenterologist Dr. Bryan Vartabedian. This time, I caught a piece on how Dr. Vartabedian handles social media communication with patients, and I thought it was well worth a share.

While your mileage may vary, here’s some key ways Dr. Vartabedian handles medical contact online with consumers:

* He never answers patient-specific questions from strangers

As he notes, people generally ask two kinds of questions, patient-specific and non-patient specific. While he’s glad to answer general questions, he never answers patient-specific ones from strangers, as it could be construed that he’s created a professional relationship with the person asking the question.

* He guides patients he’s treating offline

If an existing patient messages Dr. Vartabedian, he messages back that he’d be happy to do a phone call. He then addresses their concern via phone, while explaining to patients how both he and they could face serious privacy issues if too much comes out online. Oh, and most importantly, he documents the phone encounter, noting that the patient who reached out in  public.

* He flatly turns down requests for info from people he loosely knows

The only exception he makes is for family and very close friends.  In those cases he arranges evening phone time and spends 45 minutes getting facts so he can offer high-quality direction.

I really like the way Dr. Vartabedian has outlined his options here — it’s clear, simple, and virtually impossible to misunderstand.  It’s hard to imagine anyone being offended by these policies, or more importantly, having their privacy violated.  Good to see!

If you’re a doctor how do you handle your social media interactions with patients?

Few Doctors Ready To Qualify for Meaningful Use

Posted on May 3, 2012 I Written By

Anne Zieger 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.

A new study published in Health Affairs has confirmed what I, at least, have suspected for some time about physicians and their EMRs.  The study, which surveyed 3,996 physicians, found that while 91 percent were eligible for Medicare or Medicaid Meaningful Use programs, only 11 percent of those intending to apply had their act together.

Researchers, who analyzed data from the 2011 mail survey supplement to the annual National Ambulatory Medicare Care Survey, found that 51 percent of respondents were planning to apply for MU Stage 1 incentive programs. However, it seems that only 11 percent of doctors planning to apply have a capable enough EMR set-up to support up to two-thirds of Medicare Stage 1 core objectives.

Now, this was not completely unexpected. In the final Stage 1 MU rule, CMS had estimated that 10 to 36 percent of Medicare eligible pros, and 15 to 47 percent of Medicaid eligibles, would end up meeting the agency’s criteria.

And it should be noted, the HealthAffaits authors remind us, that about 124,000 eligibles had registered in 2011, and that CMS had paid out $275 million to 15,000 participants. Also, Medicaid programs paid out about $220 million to about 10,500 physicians.

Still, you can’t bury poor performance like this in a pile of data. Clearly, a program is lacking something important just over 1 in 10 physicians manage to set themselves up for Meaningful Use cash — especially if  they were trying hard to do so.

The problem with news items like these is that they don’t get into what’s holding physicians back. It’s actually a bit disappointing that the HealthAffairs study didn’t offer any red meat on the “Why Can’t Doctors Qualify?” issue, as we all know that talking about problems doesn’t make them go away.  (I do admit that in the world of public policy at least, simply underscoring a problem gives rulemakers ammunition to dig deeper into an issue.)

Still, I’d love to know what you’re seeing out there in terms of unprepared physicians. Are we talking practices that got fast-talked into buying inappropriate or junky technology?  Lack of understanding what they bought?  Slow-moving practices that are on the right track?