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Medicaid Doctors and Dentists Gaming the EHR Incentive Program

Posted on June 29, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I guess I should have known that it would only be a matter of time before I’d see something like this come out. As best I can tell, Dentrix has partnered with Henry Schein to offer what they’re calling Dentrix Meaningful Use Access 7.6. Seems like Henry Schein is using the Dentrix names to get Dentists access to the Medicaid EHR incentive money. On face, I don’t see any problem with this.

Although, once you start to dig into it, it appears that Dentrix and Henry Schein are partnering to get Dentists the first Medicaid EHR incentive check without even implementing the EHR. You have to remember that the Medicaid EHR stimulus money doesn’t require you to show meaningful use of the EHR. You just have to acquire the EHR technology.

Look at some of the verbiage from the website for the program:

Definition of Adopt, Implement, or Upgrade:
For Medicaid, the eligible provider must Adopt, Implement, or Upgrade (AIU) certified EHR software. As posted on the CMS website, for AIU, a provider does not have to have installed certified EHR technology. The definition of AIU in 42 CFR 495.302 allows the provider to demonstrate AIU through any of the following:
*Acquiring, purchasing or securing access to certified EHR technology
*Installing or commencing utilization of certified EHR technology capable of meeting meaningful use requirements
or
*Expanding the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the ONC EHR certification criteria.

Thus, a signed contract indicating that the provider has adopted or upgraded would be sufficient.

To be honest, I’m torn between whether this is genius or filthy. According to the letter of the law, I don’t know of any reason that someone with the right Medicaid population can’t purchase an EHR like this for $2000 and then collect the EHR incentive money. The regulations don’t require them to do any more to collect the money. Although, that’s certainly not the intent of the EHR incentive money and definitely feels like their gaming the system if they do it with no intent to actually implement the EHR.

Another piece from the website:

While Henry Schein currently has no plans to pursue a Meaningful Use solution beyond Stage 1, Year 1 for Dentrix, we continue to monitor healthcare reform to determine what subsequent steps, if any, should be taken regarding Meaningful Use criteria and certification.

At least their up front with the Dentists that they’re not planning to go beyond meaningful use stage 1, but may change their minds. I’m sure this is music to ONC’s ears to hear that they’re only committing to meaningful use stage 1.

If your strategy is to just help these dentists get the first EHR incentive check, then why should you worry about MU stage 2. Wouldn’t you love to be a salesperson for this product? Here’s your pitch: Pay me $2000 for this EHR, go through 5 steps on the government website and you’ll get paid $21,250.00.

I wish I could see something legally wrong with this idea. Someone I talked to mentioned that even for the Medicaid EHR incentive money you have to check some box saying that you comply with the HIPAA requirements. Well, these clinics have to do that anyway. Many don’t, but they’ll check that box anyway thinking that they comply whether they do or not.

The biggest surprise for me might be that Henry Schein is willing to have their name associated with a program like this. I’ll be interested to see who else picks up on this glaring issue with the Medicaid EHR incentive and what ONC/CMS/HHS do to close it up (if they can).

SCOTUS Decision and Healthcare IT

Posted on June 28, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those living in a hole that haven’t read about the SCOTUS supreme court decision that was issued today, here’s a good one paragraph summary of their decision from a post by The Atlantic:

In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.

There have been a lot of interesting reactions to the SCOTUS decision. Many of them revolve around the politics of the decision. We’ll obviously avoid the political side of the discussion for the most part. I did find HIMSS response to the ACA Supreme Court decision quite interesting. They are mostly grateful that some of the uncertainty is gone so we can move forward in healthcare. Plus, they remind people that health IT has had bipartisan support in Washington despite Obamacare’s obviously partisan issues.

Personally, I think that this decision (regardless of which way it went) will not have a major effect on the healthcare IT and EHR world. Most of the major happenings in healthcare IT and EHR aren’t related to Obamacare. There are a few places that impact it, but most are relatively innocuous.

My biggest concern with the SCOTUS decision is how it will impact healthcare reimbursement in general. Plus, the ACA uncertainty is still there since if the Republicans take control in Washington, then you can be sure that they’re going to repeal ACA as one of the first things they do. This uncertainty could affect the health IT decision making by many institutions.

I’d be interested to hear what other impacts people think the SCOTUS ruling will have on healthcare IT. I do agree with HIMSS that I’m glad we have a decision and can at least move forward with that knowledge.

Telcoms Store SMS Text Message Details – Not HIPAA Compliant

Posted on June 27, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As an extension to my previous post called “Texting is Not HIPAA Secure” I wanted to point out some data that Wired posted about Telcom’s SMS message retention policies.

The information was found in a Department of Justice document and I believe is a good illustration for why PHI should not be sent through traditional SMS text messaging. Here’s the chart that wired created showing the major Telcom providers record retention policies:

The top 2 sections are the most important when it comes to secure text messaging. Last I checked, the telcom servers weren’t HIPAA secure. Not to mention, I can’t say I’ve seen a Telcom provider sign a business associate agreement with a healthcare provider. Neither of things are likely to ever happen.

The challenge is that text message is so valuable in healthcare. It’s such a simple and flexible way to communicate between doctors, nurses, staff, HIM, etc etc etc. This is why I predict over the next year we’re going to see a huge uptick in adoption of secure text messaging by third parties. The technology is there. We just need wider spread adoption of it in healthcare.

Nuance Interviews Me and Jonathon Dreyer at Health 2.0 Boston

Posted on June 26, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m currently enjoying the depths of my first experience at ANI 2012 in Las Vegas. It’s been a really great experience meeting a number of healthcare CFO’s and some new healthcare vendors. If any of my readers are at ANI, I’d love to meet. You know how to find me on Twitter (@ehrandhit).

While I’m busy at the conference I thought I’d post some videos that Nuance did with me at Health 2.0 Boston. It was kind of fun for them to turn the tables and put me on camera with Jonathon Dreyer, Sr. Manager, Mobile Solutions Marketing, at Nuance Healthcare. The videos were broken into 3 parts: health IT trends, mobile adoption in health IT, and social media in healthcare. I hope you enjoy!

Health IT Trends

Mobile Adoption in Health IT

Social Media in Healthcare

Medicare EHR Attestation When Switching Practices Mid-Year – Meaningful Use Monday

Posted on June 25, 2012 I Written By

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.

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.

This week’s post will answer a Medicare question posed by a reader in response to Jessica’s post last week on Medicaid EHR Attestation with Multiple Practices. The reader asked about a physician who switches from one practice to another in the middle of year 2, but the answer below would also apply to a physician who works part-time at two (or more) practices.

“What about a Medicare EP who successfully attested for year one with her former employer and now works with us. Neither employer has enough information to report a full 12 months of info for her. Do we still attest for year two and fail it all or can we skip a year? And is it ok for the first employer to receive the first payment and we claim the rest? So complicated! Thanks for any input/help!!!”

Although the situation does make it more complex to attest, it does not mean that she cannot earn an EHR incentive this year. Incentives are tied to the physician—not the group—via the physician’s individual NPI number, regardless of whether the payment was made directly to the physician or assigned to the group. Therefore, even if the physician assigned payment to his former group last year, it is perfectly acceptable for her to assign payment to her new group this year. 

A physician who successfully attested and earned an EHR incentive in 2011 must report for the full calendar year in 2012 in order to earn the second payment. However, the information does not have to come from just one practice for the entire year. As long as the physician uses a certified EHR at both practices, she would simply have to report on all of the meaningful use requirements with data from both practices, combining the numerators and denominators for each measure when attesting. (For an explanation of how to report, see read CMS’s FAQ #3609.) She would also have to enter both EHRs into the CHPL website and generate a different Certification ID Number. 

If for some reason, the physician does not elect to pursue the 2012 incentive, there is no need to attest and fail this year. She can simply forego the second payment and start again with the third year’s incentive next January.

Mobile Health App Investments, Controlling Dreams With Remee: This Week in Healthcare Scene

Posted on June 24, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

While it was quiet around Healthcare Scene this week, there were still some great posts on a few of the websites. Be sure to check these articles out:

EMR and EHR

VC Firms Eyeing Mobile Health App Investments

It’s no secret that the Mobile Health App industry has taken off lately. Because of this, VC firms are more interested in investing in these companies. Anne Zeiger predicts there will be a handful of investments in the industry in the coming future. This post talks about different mobile health apps being created, and where the industry seems to be headed.

“Non Structured Data Is More Valuable to Practitioners Than Discrete Research Oriented Data” 

The title of this post was inspired by a comment on John’s recent post on the EHR Bubble. Here, John discusses the advantages of non-structured data for a physician. Does non-structured data help improve the quality of care? Join the debate over at EMR and EHR this week.

Smart Phone Health Care

Control Your Dreams With the Remee Sleep Mask

If you’re like me, I’ve always wished I could dictate what I was going to dream about. The latest product from Bitbanger Labs claims to do just that. The “Remee Lucid Dreaming Mask”, with practice, apparently gives the user the ability to control their dreams. The mask brings you into the “lucid dreaming” stage, which is a more aware state of dreaming. For only $95, this new product is available for pre-order here.

Go From Couch Potato to Runner with Couch-to-5K App

A program developed a few years ago has been the catalyst behind several mobile apps. The premise behind the program is to get couch potatoes (or just about anyone) running either a 5K or for 30 minutes straight in as little as 9 week. There are a variety of apps available to help wannabe-runners get started. This post gives a general overview of the official C25K app.

Broadband Mobile Should Change mHealth Game

Posted on June 22, 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.

You never know what you’re going to learn when you wander into a cell phone store,  other than being hit with some fairly slick marketing slicks and rapid-fire pitched on that sweet, sweet iPhone upgrade. (Sorry, letting my Apple lust get in the way here.)

In all seriousness, this time I learned something which excited the heck out of me. While this is probably old news to some readers, I was surprised to learn that the cellphone industry is now rolling out support for new mobile protocols allowing for dramatic improvements in broadband mobile speeds.

One standard, LTE, can offer peak downlink rates of 300 Mbps and peak uplinks of 75 Mbps.  LTE, which takes advantage of new digital signal processing techniques developed roughly 10 years ago, is being rolled out by more or less every major U.S. carrier. Existing 4G networks are should shoot up in capacity as well. The next revision of the family to which 4G belongs, standards-wise,  should have a throughput capacity of 627 Mbps.

So let’s bring this around to our ongoing EMR discussions.  What are the HIT implications of these mobile nodes having the throughput to process live streaming video, download multiple imaging studies, conference effortlessly with parties across the world and more?

Well, for one thing, it’s pretty clear that our idea of mHealth will have to change. It makes no sense to plan networks around data sipping apps like the current iPhone crop when you’ll soon have iPads, Android devices and even Microsoft’s Surface tablet drinking it in gulps.

Obviously, the whole notion of telemedicine will evolve dramatically, with roving doctors and nurses consulting effortlessly over mobile video.  Skype calls will be as easy to conduct as traditional calls. And reviewing charts from the road will make much more sense, including looks at, say, CT scan results.

But all of this wonderfulness will be severely constrained if EMR makers keep forcing clinicians to use their systems via mobile-hostile devices. This is the time — this month, week and even day — to admit that desktop computers aren’t the platform of choice for smart clinicians.Vendors will have to step up with native clients for remote devices, and moreover, clients that take advantage of the emerging high-speed phones and tablets. If they hang back, the whole mobile high-speed revolution won’t be happpening.

Good Luck With That HIE Tech Purchase

Posted on June 21, 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.

Want to buy HIE technology?  It’ll cost you. But more importantly, you’ll still be dealing with a bewildering array of choices, if a new report from KLAS has it right.

According to KLAS, which asked 95 providers about their HIE buying plans, there were a few clear leaders in the field.  Providers surveyed by KLAS reviewed 38 HIE vendor offerings.  Of those, five HIE vendors were considered in more than 10 percent of the providers’ buying plans, researchers found.

If there was a clear leader, it was Medicity, which was considered in 23 percent of HIE buying decisions, according to a report from Healthcare IT News.  Next was Axolotl, with 22 percent; RelayHealth, with 16  percent; ICA, with 11 percent, and Epic, also with 11 percent. (Note: Epic was only being considered seriously when providers want to tie together multiple Epic installations.)

Looked at another way — by vendors mentioned most frequently by providers — the leaders were Axolotl, Cerner, dbMotion (part owned by the University of Pittburgh Medical Center), Epic, GE, ICA, InterSystems, Medicity, Orion and RelayHealth.

If you want to really fit the HIE to your situation, consider the following criteria, the HIN story suggests:

  • Public HIEs – A public exchange may belong to official state agencies or may be semi-independent with direct and typically temporary government backing. Public HIEs demand solutions with strong potential scalability and need standards-based technology.
  • Cooperative HIEs – In this model, otherwise-competitive hospitals work together to form independent HIE organizations, generally with an open invitation to other hospitals, clinics and physician practices. These HIEs often struggle to establish long-term funding and look for vendor solutions that offer flexible and affordable cost alternatives while best adapting diverse EMR technologies.
  • Private HIEs – In some respects, private HIEs are designed to enhance relationships as well as exchange data. Often, a single hospital or IDN creates an HIE hoping to draw in community physicians while protecting or increasing revenues. Funding is less complicated and these HIEs are more likely to be satisfied with solutions that best work with their existing technology.

The truth is, though, that whatever model best fits your HIE purchase, narrowing things down to your short-list isn’t as easy as just picking from KLAS’s top contenders.  Even these leaders have a moderate to tenuous grip on the market, and may or may not have the solution that fits your model. (Note: I’m familiar with Axolotl and Orion, both of which have what may be some of the longest-deployed tech out there, but I can’t vouch that they’re exactly better than anyone else.)

If it were me, I’d look at lesser-known, strongly-backed folks focused directly on the problem. Then, I’d do a co-development program with them so both win.  Got other ideas to share readers?

Meaningful Use EHR Breakout by Percentage

Posted on June 20, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve seen a bunch of different websites listing the top 10 EHR vendors based on physicians who attested to meaningful use using their EHR software. This list is certainly interesting and worthy of a discussion. However, I think it’s also important to put these numbers in some context. Remember that these numbers are just for the ambulatory EHR space. The Hospital EHR numbers are a different story which I’ll probably cover on Hospital EMR and EHR.

Here are the EHR incentive numbers by EHR vendor and also the percentage of meaningful use attestations they had (Thanks to Dr. Rowley for the numbers):

EHR Vendor MU Attestations Percentage
Epic 11075 23%
Allscripts 5743 12%
eCW 4057 8%
NextGen 2237 5%
GE 2002 4%
Athena 1733 4%
Greenway 1650 3%
Cerner 1375 3%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 2%
Sage 1140 2%
Other EHRs (272) 14358 29%

As Dr. Rowley points out in his post, Epic is the largest vendor on the list, but they don’t market or sale their product to independent clinics or even independent physician groups. Epic’s ambulatory EHR is found in owned or affiliated clinics who use the ambulatory piece of the EHR an Epic hospital buys. So, the above Epic number actually provides an insight into how many ambulatory practices are associated with Epic using hospitals.

The numbers tell an interesting story if you take Epic out of the mix:

EHR Vendor MU Attestations Percentage
Allscripts 5743 15%
eCW 4057 11%
NextGen 2237 6%
GE 2002 5%
Athena 1733 5%
Greenway 1650 4%
Cerner 1375 4%
MEDENT (Previously Community Computer Service) 1264 3%
e-MDs 1235 3%
Practice Fusion 1156 3%
Sage 1140 3%
Other EHRs (272) 14358 38%

Once you take out the hospital dominance in the ambulatory market, the EHR market share for any one EHR vendor is quite small. In fact, the other EHR vendor category has 38% of the EHR market. The long tail of EHR software is definitely at play right now.

Plus, we have to be really careful using meaningful use attestation as a proxy for the EHR market. I recently saw a figure that only 20% of the ambulatory EHR market had attested to meaningful use. That’s right, the above numbers only represent 20% of the ambulatory market.

If my math is correct, that still leaves almost 200,000 providers that aren’t represented in the above analysis of 50k providers. Imagine an EHR vendor comes along that’s so great that they quickly capture only 20% of the 200,000 uncounted providers (no small feat). That would give them about 40,000 providers and using the above numbers they would have 45% of the EHR market (including Epic).

Of course, the current EHR vendors will continue to sale EHR software and many will switch EHR software vendors during that time as well. Plus, no doubt many of those who haven’t attested to meaningful use already have an EHR, but aren’t represented in the numbers above. They just either don’t care about meaningful use and EHR incentive money or they’re still working to get to the point where they can attest to meaningful use. However, I still think the above numbers illustrate that there’s plenty of opportunity available for an upstart EHR company to get plenty of EHR market share.

It’s going to be an exciting next couple years as we watch all of this shake out. We’ll take a look back at this post in a few years to see how far we’ve come.

Accountable Care Organizations and SCOTUS

Posted on June 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Supreme Court ruling on SCOTUS is likely to come sometime this month. There are all sorts of opinions out there about what’s going to happen to the ruling, but a recent tweet caused me to stop and think about the real impact of SCOTUS. The tweet (which sadly I can’t find again) said something about the Supreme Court’s ruling on Obamacare and SCOTUS really doesn’t matter to healthcare since the change in care model has already been started.

I take one slight exception to this comment. I agree that the ACO (Accountable Care Organization) movement and all that it embodies is already upon us and won’t be affected by the Supreme Court’s decision on SCOTUS. However, I think the SCOTUS legal decision does matter and will still have an impact on healthcare. Not to mention the politics related to the decision. Although, I’ll leave both of those topics for a different blog.

I do think it’s worth exploring ACOs and why SCOTUS or NO-SCOTUS, ACOs are here to stay in healthcare.

Dave Chase recently said in a Forbes article that “More than 80% of the newly formed ACOs are driven solely by private sector efforts.

I believe that Dave Chase got these numbers from an ACO Watch article about a Leavitt Partners study on ACO growth and dispersion. It’s a powerful number to consider that despite all the efforts by government to move to accountable care organizations that only 20% of the newly formed ACOs came from the government. What a healthy thing and a great illustration of why SCOTUS won’t impact ACOs in any major way.

Dave Chase in the above linked article adds this additional quote from Philip Betbeze:

As Philip Betbeze stated, “In their day-to-day-lives, it [the SCOTUS decision] largely won’t affect the 180-degree shift they’re making in reimbursement philosophy. For most systems, those changes are taking place largely at the behest of commercial plans and local employers.” The fee-for-value train has left the station. Woe is the health system that hasn’t made aggressive moves to reinvent themselves.

We’re still early in the reimbursement philosophy switch, but the winds of change are upon us. Personally I’m excited to see how health systems reinvent themselves. I think this reinvention will be around these key pillars:

*Communication – ACO’s will drive better communication. This will include patient to doctor, doctor to doctor, and even patient to patient. The beauty is that in an ACO, the goal will be for the patient not to come to the office instead of the de facto, come to the office answer most practices give today.

*Data – Practices better be preparing for the tsunami of healthcare data on the horizon. How an ACO takes that data and uses it to improve patient care is going to be key.

If you look at these pillars of an ACO, are they even possible to deal with without technology?