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Moving from “Reporting on” to “Leading” Healthcare – A Conversation with Dr. Halee Fischer-Wright, President & CEO of MGMA

Posted on October 11, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

In Chapter 3 of Dr. Halee Fischer-Wright’s new book Back to Balance, she writes: “People are increasingly being treated as if they are the same. Science and data are being used to decrease variability in an attempt to get doctors to treat patients in predictable ways.” This statement is Fischer-Wright’s way of saying that the current focus on standardization of healthcare processes in the quest to reduce costs and increase quality may not be the brass ring we should be striving for. She believes that a balance is needed between healthcare standardization and the fact that each patient is a unique individual.

As president of the Medical Group Management Association (MGMA), a role Fischer-Wright has held since 2015, she is uniquely positioned to see first-hand the impact standardization (from both legislative and technological forces) has had on the medical profession. With over 40,000 members, MGMA represents many of America’s physician practices – a group particularly hard hit over the past few years by the technology compliance requirements of Meaningful Use and changes to reimbursements.

For many physician practices Meaningful Use has turned out to be more of a compliance program rather than an incentive program. To meet the program’s requirements, physicians have had to alter their workflows and documentation approaches. Complying with the program and satisfying the reporting requirements became the focus, which Fischer-Wright believes is a terrible unintended consequence.

“We have been so focused on standardizing the way doctors work that we have taken our eyes off the real goal,” said Fischer-Wright in and interview with HealthcareScene. “As physicians our focus needs to be on patient outcomes not whether we documented the encounter in a certain way. In our drive to mass standardization, we are in danger of ingraining the false belief that populations of patients behave in the same way and can be treated through a single standardized treatment regimen. That’s simply not the case. Patients are unique.”

Achieving a balance in healthcare will not be easy – a sentiment that permeates Back to Balance, but Fischer-Wright is certain that healthcare technology will play a key role: “We need HealthIT companies to stop focusing just on what can be done and start working on enabling what needs to be done. Physicians want to leverage technology to deliver better care to patient at a lower cost, but not at the expense of the patient/physician relationship. Let’s stop building tools that force doctors to stare at the computer screen instead of making eye contact with their patients.”

To that end, Fischer-Wright issued a friendly challenge to the vendors in the MGMA17 exhibit hall: “Create products and services that physicians actually enjoy using. Help reduce barriers between physician, patients and between healthcare organizations. Empower care don’t detract from it.”

She went on to say that MGMA itself will be stepping up to help champion the cause of better HealthIT for patients AND physicians. In fact, Fischer-Wright was excited to talk about the new direction for MGMA as an organization. For most of its history, MGMA has reported on the healthcare industry from a physician practice perspective. Over the past year with the help of a supportive Board of Directors and active members, the MGMA leadership team has begun to shift the organization to a more prominent leadership role.

“We are going to take a much more active role in healthcare. We are going to focus on fixing healthcare from the ground up –  from providers & patients upwards. In the next few years MGMA will be much bigger, much strong and even more relevant to physician practices. We are forging partnerships with other key players in healthcare, federal/state/local governments and other associations/societies.“

Members should expect more conferences, more educational opportunities and more publications on a more frequent basis from MGMA going forward. Fischer-Wright also hinted at several new technology-related offerings but opted not to provide details. Looking at the latest news from MGMA on their revamped data-gathering/analytics, however, it would not be surprising if their new offerings were data related. MGMA is one of the few organizations that regularly collects information on and provides context on the state of physician practices in the US.

It will be exciting to watch MGMA evolve in the years ahead.

Inspector General Says CMS Made $729 Million In Questionable EHR Incentive Payments

Posted on June 16, 2017 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 report from the HHS Office of Inspector General has concluded that over a three-year period, CMS made roughly $729.4 million in EHR incentive payments to providers who didn’t comply with program requirements.

To determine whether the incentive program was functioning appropriately, the OIG audited payments made between May 2011 to June 2014.

After sampling payment records for 100 eligible professionals, the agency found 14 EPs, who received payments totaling $291,022, who didn’t meet incentive criteria.  The auditors found that the 14 had either failed to meet bonus criteria or didn’t provide proof that they had.

Then, the OIG used the data to extrapolate how much CMS had spent on invalid payments, which is how it arrived at the $729 million estimate. In other words, given the margin of error across the sampled incentive payments, the OIG assumed that 12% of all incentive payments were in error. (The analysis also concluded that CMS mistakenly paid $2.3 million to EPs switching between Medicare and Medicaid programs.)

Not surprisingly, the OIG has recommended that CMS recover the $291,000 in payments made to the sampled providers. It also suggested that the agency review EP payments issued during the audit period to see what other errors were made. Of course, the ultimate goal is to get back the approximately $729.4 million the agency may have paid out in error.

In addition, the OIG  called on CMS to review a random sample of self-attested documentation from after the audit period, to determine whether additional inappropriate payments were made to EPs.

And to make sure the EPs don’t get payments under both Medicare and Medicaid incentive programs for the same program year, the report urged CMS to conduct edits of the National Level Depository system.

As part of this report, the OIG noted that allowing providers to self-report compliance data leaves the incentive payment program open to fraud, and recommended keeping a closer eye on these reports. CMS seems to have had at least some sympathy for this argument, as it apparently agreed partly or fully with all of the OIG’s suggested actions.

One side effect of the OIG report it brings back attention to the Meaningful Use program, which has been eclipsed by MACRA but still clings to life. Eligible providers can still report either Modified Stage 2 or Stage 3 in 2017, the main difference being you need a full year of data for Stage 2 but only 90 days for Stage 3.

But MACRA does change things, as its performance standards will test providers in new ways. This year, providers have a chance to get situated with either the MIPS or APM track, and those who jump in now are likely to benefit.

Meanwhile, the future of Meaningful Use remains fuzzy. To my knowledge, the agency has no immediate plans to restructure the current incentive program to audit provider reports in depth. In fact, given that providers are more concerned about MACRA these days, I doubt CMS will bother.

That being said, it’s fair to assume that incentive payouts will get a bit more attention going forward. So be prepared to defend your attestation if need be.

The Impact of the 2016 Election on Healthcare IT

Posted on November 9, 2016 I Written By

John Lynn is the Founder of the 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 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.

Today it’s pretty obvious that the Presidential is on everyone’s mind. While I don’t plan to discuss the details of the election and the specific results, it’s worth thinking about what Donald Trump in the white house will mean for healthcare IT.

Let’s start off with the easy one: Meaningful Use/MACRA. One doctor tweeted me that now that Trump is President, MACRA will be gone. I don’t think that’s further from the truth. In fact, I really can’t imagine any scenario where the EHR Incentive program (Meaningful Use, which still applies to hospitals and Medicaid) and the MACRA program would be gone. I think they’re here to stay and won’t be altered at all by this election.

The biggest reason for this belief is that Trump is going to have so many other things on the agenda. Not the least of which is ACA (Obamacare), which we’ll get to later in this post, but also a whole suite of other things that he’ll make a priority. Why would Trump want to take on a relatively bipartisan thing like healthcare IT, EHR and MACRA? I don’t think he’ll waste a second on the subject.

Plus, even if Trump wanted to go after the MACRA and EHR incentive legislation, I can’t imagine the Senate and House passing something to replace those programs either. Remember that Trump can propose all he wants, but the Senate and House have to pass it too and both of those groups seem to be firmly behind both efforts. Add this to the previous point and why would Trump go after health IT when it’s unlikely to pass and isn’t a strategic goal of his? Short Answer: He won’t.

My opinion: we’re unlikely to see any change to MACRA and other healthcare IT initiatives.

The trickier part to assess is the impact a Trump presidency will have on the Affordable Care Act (ACA or Obamacare). I live in Vegas and I wouldn’t even want to offer odds on what’s going to happen there. The rhetoric out there is to “repeal and replace Obamacare.” What’s not clear to me is if this concept is even practical and possible. There are so many issues with the idea of repealing Obamacare, that I can’t imagine it ever happening. I could see parts of it being repealed, but not the whole thing.

I also think it would be seen as very unfavorable for Trump to roll back things like the pre-existing condition exemption that allows those with pre-existing conditions to get insurance. There are probably a dozen other things like this that would likely be hard to take back without some major backlash and so I think they’ll have to preserve many of these things in whatever they do with Obamacare. Maybe that means a full repeal, but then rolling back in some of the popular pieces of the legislation so they can say they repealed it.

All of this said, I think that Trump will evaluate all options to undermine many of the things that were implemented by Obamacare including the insurance mandate and the insurance exchanges. Most people don’t realize that there’s so much more to Obamacare than just the mandate and exchanges. How he’ll undermine Obamacare and the impact it will have is anybody’s guess. I’m not sure anyone really knows and it’s certainly beyond my political punditry.

Long story short on Obamacare, I have no idea. I know that something’s going to happen because of the strict “Rip and Replace” rhetoric. I just think it’s really hard to predict which parts they’ll be able to rip out at this point and what they’ll replace it with going forward.

No doubt this will keep many in healthcare on edge. Unknowns are always a challenge. While I think the Trump Presidency will likely have a big impact on healthcare, I don’t see it having a big impact for good or bad on healthcare IT. I think the path to healthcare IT is happening and he won’t do anything to really stop it.

Side Note: Check out this interesting lessons learned post by Mr. H at Histalk which talks about the challenge of relying on data. As healthcare enters the world of data in a big way, it’s important to make sure we have a good understanding of what the data really tells us and what it doesn’t.

Expecting Evolutionary, Not Revolutionary at #HIMSS16

Posted on February 26, 2016 I Written By

John Lynn is the Founder of the 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 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.

As most of you know, I’m deep in the weeds of planning for the HIMSS 2016 Annual conference. Actually, at this point on the Friday before HIMSS, I’m more or less planned. Now I’m just sitting here and wondering what things I might have missed. With that said, I’ve been preparing for this live video interview with the Samsung CMO which starts in 30 minutes (it’s recorded in case you miss the live discussion) and so I’ve been thinking about what I’m going to see at HIMSS. As someone who follows the changes in healthcare technology every day, I’m expecting lots of evolutionary changes and very little revolutionary.

As I think about it, I’m trying to imagine what someone could announce that would be revolutionary. That includes thinking back to past HIMSS to what announcements really revolutionized the industry. I can only think of two announcements that come close. The first announcement was when the meaningful use regulations were dropped right before the ONC session at HIMSS. Few people would argue that meaningful use has not revolutionized healthcare IT. Certainly many people would argue that it’s been a revolution that’s damaged the industry. Regardless of whether you see meaningful use as positive or negative, it’s changed so many things about healthcare IT.

The second announcement that stands out in my mind was the CommonWell health alliance. I’m a little careful to suggest that it was a revolutionary announcement because years later interoperability is still something that happens for a few days at the HIMSS Interoperability showcase and then a few point implementations, but isn’t really a reality for most. However, CommonWell was a pretty interesting step forward to have so many competing EHR companies on stage together to talk about working together. Of course, it was also notable that Epic wasn’t on stage with them. This year I’ve seen a number of other EHR vendors join CommonWell (still no Epic yet), so we’ll see if years later it finally bears the fruits of what they were talking about when they announced the effort.

The other problem with the idea that we’ll see something revolutionary at HIMSS 2016 is that revolutions take time. Revolutionary technology or approaches don’t just happen based on an announcement at a conference. That’s true even if the conference is the largest healthcare IT conference in the world. Maybe you could see the inkling of the start of the revolution, but then you’re gazing into a crystal ball.

The second problem for me personally is that I see and communicate with so many of these companies throughout the year. In just the last 6 months I’ve seen a lot of the HIMSS 2016 companies at various events like CES, RSNA, MGMA, AHIMA, etc. With that familiarity everything starts to settle into an evolution of visions and not something revolutionary.

Of course, I always love to be surprised. Maybe someone will come out with something revolutionary that changes my perspective. However, given the culture of healthcare and it’s ability to suppress revolutionary ideas, I’ll be happy to see all the amazing evolution in technology at HIMSS. Plus, the very best revolutionary ideas are often just multiple evolutionary ideas combined together in a nice package.

$15+ Billion of Ongoing Meaningful Use Spending Will Change Nothing

Posted on October 16, 2015 I Written By

John Lynn is the Founder of the 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 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.

In case you missed it, Jeb Bush put out his healthcare plan and called for termination of the meaningful use program. Here’s that section of his plan:

Promote private sector leadership of health information technology adoption: Lead private sector collaboration, rather than government mandates, to establish national standards for electronic health record features and data interoperability; eliminate government mandates and penalties for health care providers who do not use government-approved electronic health records; protect health information from hackers and cyber attacks; and enable patient ownership of their medical history and records. Individuals should have access to their longitudinal medical records, which will help providers offer more personalized and timely treatments for individuals.

This sounds a lot like my plan to blow up meaningful use and focus on interoperability. I think it’s the right strategy and the more I think about the future of meaningful use, the more I’ve realized that it needs to end (at least in its current form).

I’ve been talking with a lot of people lately and I’ve been asking them this fundamental question: If the government chose not to spend the ~$15 billion of meaningful use money that remains would it change the trajectory of EHR adoption and EHR use at all?

There are a number of ways to look at the answer to this question. First, all of the remaining meaningful use money has basically been spoken for. I can’t think of anything anyone can do to change which companies are going to get the EHR incentive money. Everyone that’s going to get future EHR incentive money has already purchased their EHR and that $15 billion is already more or less committed to the various EHR vendors. Meaningful use has essentially locked practices into their current EHR and that’s not going to change (give or take a few hundred million).

Second, what major benefits will continued participation in meaningful use bring healthcare? This is an important question. If the government’s going to continue spending $15 billion on this program, don’t you think we should be able to trace that spending to specific benefits we’re going to receive? One way to look at this is to consider the benefits we’ve received from the first ~$20 billion (Medicare) (and another $10 billion for Medicaid) spent on meaningful use. We’ve seen adoption of EHRs. That I can’t argue. However, it’s hard for me to argue much benefit beyond it. Looking at the future meaningful use stages, I’m not optimistic of the benefits future meaningful use compliance will bring either. I’d love to hear if you have a different perspective.

I do know hundreds (probably thousands) of doctors who would argue that continuing the meaningful use program will not only not provide us any benefits, but will actually cause harm to health care. They would argue that meaningful use is a tax on their time and it provides no actual value to them or their patients. This is evident when you consider the number of doctors who have chosen not to participate in meaningful use even though they know doing so is going to cause them to incur penalties. Think about that. Many doctors think the cost to participate in meaningful use is more expensive than the guaranteed penalties for non-participation.

Returning back to the government perspective, is it wise for the government to spend another $15 billion on a meaningful use program which will actually do more harm than good?

The one challenge with the idea of discontinuing meaningful use is that it will make some organizations that were planning on the money angry. I get it. If you’re a hospital that just spent a few hundred million dollars on an EHR with the expectation that you’d be getting paid the meaningful use money, meaningful use being terminated would be quite a blow. Same goes for small practices that have invested in an EHR with the hope of EHR incentive money. I’m sympathetic to this challenge.

The solution is simple though. You find another more meaningful (pun intended) way to spend the $15 billion so these organizations can still recoup some of the investment they made in their EHR software. The meaningful way to do this is to pay them for being interoperable. Disregard all the other prescriptive elements of meaningful use and create a much simpler program that’s focused around healthcare organizations sharing data. Incentivize healthcare organizations to do something we all know is the right thing to do but which has no natural incentive. Focus the incentive on the outcome.

Am I optimistic this will happen? No. Unfortunately, I think it would take some legislative action for CMS and ONC to be able to do this. They can’t just do it on their own (I believe). Given the state of affairs in Washington, I can’t imagine congress caring enough about $15 billion here or there. It’s sad to say, because so much more could be done to improve healthcare as we know it if that $15 billion were part of the right incentive program. As it is, if the meaningful use program were cut today or the money is spent, I don’t see either action changing the trajectory of EHR and healthcare IT in a significant way.

Are Some Healthcare Organizations Heading Towards EHR Induced PTSD?

Posted on October 6, 2015 I Written By

John Lynn is the Founder of the 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 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.

I want to be careful with this analogy since I know that there are millions of people out there that suffer from PTSD. Many of these people have gone untreated and haven’t gotten the help they need. It’s a failing of our healthcare system in many ways and I hope that it’s one we work to resolve. I don’t want to treat these challenging mental condition lightly. However, as I look at the world of healthcare IT and EHR in particular, I see some similarities which might help some organizations avoid an organizational PTSD due to their EHR.

The Mayo Clinic website describes PTSD as follows:

Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event — either experiencing it or witnessing it.

While the analogy isn’t perfect, I’ve seen so many healthcare organizations that are in a haze in this post-EHR implementation world. The race to select and implement their EHR as they chased the government EHR incentive money was so quick that many healthcare IT organizations see their EHR implementation as a “terrifying event” for their organization and many still haven’t recovered from the event. In fact, I’m sure there are some that aren’t sure they’ll ever be able to recover.

Let me be clear that I’m talking about heading towards an organizational PTSD and not an individual one. While there might be a few massive EHR failures that could fall into individual PTSD, those would be very rare. However, there are plenty of healthcare organizations who have been so focused on their EHR implementation that they’re kind of shell shocked when it comes to where to guide their organization next.

This additional description about PTSD from the Mayo website is helpful as well:

Many people who go through traumatic events have difficulty adjusting and coping for a while, but they don’t have PTSD — with time and good self-care, they usually get better. But if the symptoms get worse or last for months or even years and interfere with your functioning, you may have PTSD.

No doubt, the majority of healthcare organizations aren’t going to fall all the way into an organizational PTSD due to their EHR implementation. That doesn’t mean we should discount that their EHR implementation might have been a “traumatic event” and that they’ll have “difficulty adjusting and coping” with the changes for a while. We see that across healthcare. I’m sure that most health IT vendors selling into that marketplace are very familiar with the current shell shocked state of the industry. However, in time things will get better and they already have for many organizations. This is why I’m so excited for the future of healthcare IT.

With that said, there will be a few outlier organizations which can’t recover and fall into full organizational PTSD. How can you know if your organization is in jeopardy of this happening? I’d consider two questions as you evaluate your organization. How many EHR projects keep going around in circles? and How many non-EHR health IT projects have you done?

I get that EHR has been all consuming and future regulations like meaningful use stage 3 could make things even more challenging. However, I’ve seen so many organizations stuck spinning their wheels on the same EHR issues over and over. Usually this is a reflection of poor leadership. Effective leadership is the only way I know how to solve this problem. A quality leader doesn’t let these problems fester and become a permanent burr in the side of an organization. Leaders work with their teams to find the very best solutions possible and communicate with stakeholders the efforts they made to solve challenges and the compromises that were required. When this doesn’t happen EHR projects go around in circles and lead to organizational PTSD. Once that happens it usually leads to an organization being bought out by another organization.

The second question is just as interesting to me. Think about your organization and the last non-EHR related healthcare IT projects you’ve done. Some might even ask themselves when they last thought about or spent time discovering what other non-health IT projects could benefit their organization. Have you started moving beyond the EHR or is your EHR still paralyzing you?

I get that the EHR is the heart of a healthcare organization. That’s not going to change any time soon. Healthcare organizations need to make sure their heart is working properly or they’ll have other issues. However, we need to move beyond the EHR and meaningful use and not get stuck in an organizational PTSD state.

Eyes Wide Shut – Making the Most of Meaningful Use, for Healthcare Providers, Insurers, and Patients

Posted on July 21, 2015 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

When I ask a room of 100 health plan leaders, “how many of you know what HL7 is,” and only a third raise their hands, I realize there had been a “Meaningful Use” for my recent travels through the healthcare provider system and its maze of regulatory and payer mandates. I navigated change management hell in order to inform my future endeavors. I came out on the other side of an attestation nightmare with the knowledge to educate others who are embarking on extensions of that journey. This “Eyes Wide Shut” series has come full-circle.

For those who have followed this series, a quick update on the fate of the IDN highlighted throughout earlier posts: they have not yet successfully attested to all Meaningful Use Stage 2 measures across all the inpatient facilities and ambulatory practices. However, the continuing changes to attestation criteria (specifically, the engagement measures that caused so much consternation) may allow them to squeak in under the wire in fiscal year 2016 before penalties kick in. Although I’m no longer directly involved in the IDN’s pursuit of multi-EMR integration excellence, I am a “beneficiary” of those encounter data normalization efforts, as I am back to working with payer clients who are leveraging this clinically-integrated network. And I’m still having to adjust for inconsistencies in identity management rules, coding practices, and clinical workflow differences across each of the offices (and departments within offices), as I integrate their information with the insurer’s data ecosystem.

I began this series on my (woefully neglected) personal blog, almost 2 years ago: Eyes Wide Shut: Seeing the Dark Side of Health IT Mandates and Meaningful Use. Coming from the health insurance world, I had no idea of the magnitude of healthcare provider process impacts resulting from regulatory and payer demands (nee, mandates). I was insensitive to the plight of the independent general practitioner, and the size of the budget required to implement a certified EMR, let alone populate it with any patient history or integrate it with existing scheduling or billing processes. I didn’t realize that my request for chart data to support HEDIS measures would involve more work than simply clicking an indicator in an EMR configuration screen to suddenly send me my heart’s desire of data elements. I would never have believed that certified software would not be tested for conformance to code-level specifications (only visual output tests).

To all my clinician and provider office-worker friends: I am sorry for all the ways in which this ignorance may have contributed to the new reality forced on practitioners of medicine to also be data-entry clerks/contract lawyers/IT experts. Personally, I want my doctor to be my doctor. So, I’m dedicating the next leg of my career journey aligning all healthcare system actors to what should always have been our higher purpose: contributing positively to the health and well-being of the individuals and populations we serve.

When I initially began writing this post, I thought I’d be using it to end the series.

Instead, I’m just embarking on a new chapter: the post-provider world of healthcare actor convergence.

Great Meaningful Use and Eligible Providers Chat

Posted on April 29, 2015 I Written By

John Lynn is the Founder of the 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 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.

I recently received an email from a regular reader, Dr. Mike, who owns a single specialty ortho group. In the email Dr. Mike talks about the challenges that Eligible Providers (EPs) are facing with meaningful use stage 2. He describes the story as falling on “deaf ears” at CMS and ONC. He also offered these stats on meaningful use to illustrate his case that meaningful use is a failure:

Only 38,472 have attested to Stage 2, My guess is that only about half actually did Stage 2 as there was the Stage 1 reprieve. Even so, that is only 18% of EPs have successfully attested which is an complete failure of MU.

Then, he asked me an important question:

Someone ask CMS and ONC the tough questions please…Now what are they going to do?

In response to him, I told him that I’d been talking about the challenge that meaningful use is for doctors for quite a while. However, I also told him that most hospitals are participating in meaningful use, so “we’ll see how that plays out.” What I meant is that in the meaningful use program we now have one group (EPs) that are not doing so well with meaningful use and their hospital counterparts that are relying on the millions in EHR incentive money (not to mention avoiding the penalties).

Then I answered his important question, “I can tell you what ONC and CMS are going to do. Spin It!”

Of course, Dr. Mike is great at engaging in conversation so he offered this reply:

1. Elizabeth Myers and the rest of CMS and ONC really did try to spin every bad number and “we cannot assess the numbers yet” was a constant theme.
2. I totally agree they will continue to try to spin the numbers or ignore them as long as possible. I’m not sure why they cannot face the truth about MU.
3. The 36K that did MU 2 are the cream of the crop. I would even argue that the other 82% are the cream also as they were the early adopters and gung ho about MU. The fact that 82% of the over achieving EPs have skipped out on MU 2 is a travesty. There is NO chance ONC and CMS is going to pull in the lagging EPs.
4. If you don’t know already, I own a single specialty Ortho group and we skipped MU completely after we saw the MU 2 rules. Proposed MU 3 just help us box it up and bury it.

I have no idea why ONC and CMS cannot let go of the program, let EHR vendors actually work with EPs for all the thing we are missing from our IT (usability, safety, security, efficiency). Right now we cannot do anything to customize our workflow or improve our experience as it will potentially decertify the EHR for MU. MU sucks all the air out of the room. EHRs right now are a billing and click box for MU system with a marginal clinical system slapped on…

Its about time ONC lets the market do its thing, instead of this constant objective, measures, menu, core, numerators, denominators, attesting, auditing disaster they created.

Once EPs leave the program, they are not coming back. So this should be a big deal for ONC and CMS.

I haven’t gone in and fact checked his numbers (I’d love to hear if you have different numbers), but the emotion in his comments is something I’ve heard from many providers. In fact, I’ve heard it from many EHR vendors. They’re tired of coding their EHR software to the test and the government regulations as well. They want to do more innovative things, but the government regulations are stifling their ability to do it. Resources only go so far.

I think we’re in the early days of provider discontent with meaningful use. However, it’s starting to boil. I’ll be interested to see what happens when it boils over. I’m predicting that will happen once many of these doctors start seeing the penalties hit their pocketbooks.

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.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

Posted on June 30, 2014 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?