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Three Tips for Hiring Better Front-Desk Staff

Three Tips for Hiring Better Front-Desk Staff | Healthcare and Technology news |

Many practices really struggle with hiring and training a front-desk person (the person who will create that all-important first impression for your practice). The struggles are real; most offices budget near-minimum wage for this position and seem to have difficulty finding the right person to handle the huge responsibility of this position.

My go-to answer for this problem is to pay a little more in salary to recruit for this position. It's true; you often get better quality applicants if you can raise the hourly rate of pay for this vital position. It can be difficult to find a professional with the type of experience you are looking for if you only pay a low hourly rate.

But if you can't find the extra money to increase salary, what other options are available that won't necessarily cost more? Here are some options:

1. Rearrange responsibilities.

Perhaps you should take away appointment scheduling from the front desk, as there are often face-to-face patients requiring more attention. Calls could be redirected through an automated PBX system to another staff member.

2. Search for candidates with a high attention to detail.

This is as simple as giving applicants specific instructions to follow. If they don't follow those instructions in the application process, exactly, then don't even give them a second look. After all, if they are responsible for the first impression in your office, they should be diligent in making the optimal first impression to you.

3. Hire for personality and train the skills.

You can't train someone into a bright, sunny, and welcoming demeanor. So hire for personality, attitude, and work ethic — the skills and other aspects of the job can be taught.

It doesn't have to cost you more money to find the perfect front-desk staff member. There are great candidates out there to meet every budget, who will help you create stellar front-desk first impressions.

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Practices Should Prepare for Payer Consolidation

Practices Should Prepare for Payer Consolidation | Healthcare and Technology news |

We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.

With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.

Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  

As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.

The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.

Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

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Demand for Advanced Practitioners Will Continue to Grow

Demand for Advanced Practitioners Will Continue to Grow | Healthcare and Technology news |

Like the rest of Americans and people around the world, I eagerly awaited the Supreme Court decision on King v. Burwell. The decision, which shifts the direction of the healthcare reform debate, also affirms the demand for physicians, especially family-practice-trained physicians, and other advanced practitioners, such as PAs, NPs, and CRNAs, will continue to skyrocket.

The Association of American Medical Colleges (AAMC) studies the supply and demand of physicians, and indirectly, other providers who perform services in the healthcare system. The most recent report discusses research and findings within the lens of Affordable Care Act (ACA) initiatives and programs having been underway for several years.

The summary essentially reinforces the need to train more physicians, and clinicians such as PAs, NPs, and CRNAs. The ACA has increased the demand for providers at all levels, over previous predictions, and that demand will only continue to grow as more patients continue to enter the healthcare system.

Key findings in the report were as follows:

• The AAMC predicts a projected shortfall between 12,500 to 31,100 primary-care physicians by 2025, while demand for non-primary care (specialty) physicians will exceed supply by 28,200 to 63,700 physicians. This has significant impact especially on PAs, in that we practice in teams with physicians.

• Expanded medical coverage achieved under ACA, once fully implemented, will likely increase demand for healthcare providers, especially those in primary care, by about 2 percent over the current increased demand resulting from changing demographics.

• Due to new data and the dynamic nature of projected assumptions, the projected shortfalls of physicians in 2025 are smaller than shortfalls projected in the earlier study. The lower ranges of the projected shortfalls reflect the rapid growth in supply of clinical providers such as PAs, which have helped to close the gap between physician supply and demand.

• The critical role PAs play in patient care delivery has implications for all providers on the healthcare team. Right now, we cannot train physicians, PAs, and NPs fast enough to meet the demands of the healthcare system.

The AAMC concluded that additional study is needed to determine the impact that providers like PAs have on the supply and demand of physicians. As always, hindsight is 20/20, and the AMCC recognized the limitations and caveats of making predictions about the supply and demand of all members of the healthcare delivery team. Areas of future recommended study included physician retirement patterns, changing wants, needs, and preferences of young physicians, the evolution of clinician staffing patterns, and the effect of payment models.

Speaking for PAs, all of the above areas of future research are important to my profession, especially in the area of retirement. As a growing profession, we are experiencing the first major cohort of PAs approaching retirement. However, as the demand for providers increases, demand for PAs is also skyrocketing due to our rigorous education in the medical model — similar to physicians — and our training in team-based care (on which many new models of care delivery depend).

As PAs practice medicine in nearly every setting and every specialty and subspecialty, our future continues to be tied to the present and future supply and demand challenges confronting our health system. To meet the ever-expanding demand and reflect the realities of today's U.S. healthcare system, it is more important than ever to modernize laws and regulations to allow PAs to practice to the fullest extent of their education and abilities.

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Online health info balances power between patients, docs

Online health info balances power between patients, docs | Healthcare and Technology news |

Online health information can empower patients and even shift the balance of power between patients and their doctors, according to an article at the Journal of Medical Internet Research.

The study is based on focus groups with 32 participants recruited from an arthritis research center in British Columbia, Canada. Participants were asked to talk about the types of online health sites they visited as well as how the information they gleaned affected their relationships with their doctors.

The participants looked to sites that include university and medical webpages, as well as social media sites (Twitter and Facebook), chat rooms and other sites for information on research and treatment options, medication self-management strategies and resources.

Three predominant themes emerged from the discussions: the changing roles patients have with their doctors, partnership in their healthcare and tensions and burdens.

About the changing roles, one participant said, "Before we would accept what the doctor said, but in the last 10 years, we've had access to the information and now we question more." Along with more information, patients reported the need to be better prepared to discuss issues with their doctor based on what they learned online.

The study's participants, all of whom had multiple chronic health conditions, discussed teamwork and emphasized the importance of effective communication with multiple doctors.

One patient conveyed how online information equipped her to change the power balance, be heard and get support from her doctors, saying online information is "ammunition."

The participants also noted downsides, such as feeling overwhelmed and frustrated with the amount of information to wade through.

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What new doctors don't realize. And it's holding them back.

What new doctors don't realize. And it's holding them back. | Healthcare and Technology news |

She wants to be busy, with lots of patients, operating every day. In fact, it is better not be busy, and instead to think long and hard about each patient, listening, pausing, recommending non-operative treatments and being patient. Doctors learn the most from the patients they take the time to truly listen to and care for with extreme attention and lovingness. They learn nothing from those they have little time for.

A new doctor wants to market himself. He wants to tell the world how well trained he is, how up to date he is with the literature, how knowledgeable he is about the latest techniques and tools. What he should really do is read more than he speaks, listen more than he argues, and apply the accepted techniques, while ever so slowly introducing novel approaches. He should stay under the radar, find and cultivate the wisest mentors, stand behind the pillars of the community, and gain their trust for several years before challenging and eventually leading them.

The new doctor wants to computerize, modernize, electronic medical ‘recordize’, and robotize every aspect of medical care. What she doesn’t realize is that most of the current digital data is not compatible with any other system, can’t be moved to a new hospital, and is subject to viruses, malware, and corrupted programs. Mostly likely, 20 years from now, all her computerized records will be unreadable, inaccessible, and useless. She must take note of the growing trend of a computer humming between every doctor and their patient, further distancing the doctor from learning the subtleties of the patient and of medicine, and she must find a way to overcome this.

The new doctor wants security while making money, independence while having a job, freedom to practice while contracted with insurance companies. What he doesn’t realize is that the security of working for someone else can evaporate in the first downsizing; the independence once visualized in medical practice is lost when taking a paycheck, the freedom to practice crushed when contracting with the lowest cost bidders, i.e., the health plans. The socialization of medicine is a choice a doctor makes when they choose not to work independently.

The new doctor wants to lead her field. She understands that performing research, presenting papers, writing books, and lecturing are the paths to stardom. She doesn’t understand how to do this while also practicing full time and meeting the financial and personal demands of a new practice and maybe a family. What she really needs to do is accept that to be both a fabulous doctor and a researcher one must commit full-time to both, integrating the research directly into the practice and setting the practice up to permit the research. It is all possible, and definitely worth it, though the sacrifices are usually financial and personal for many years.

New doctors want to be all that they can be on day one. The reality is that each decision on how to become the superstar affects the likelihood of getting there, and that patience, exquisite care of each patient, quiet tactical maneuvering, phenomenally hard work and a low profile early on under the guidance of wise mentoring is by far the best way.

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Even Without Meaningful Use Dollars, EMRs Still Selling

Even Without Meaningful Use Dollars, EMRs Still Selling | Healthcare and Technology news |

I don’t know about you, readers, but I found the following data to be rather surprising. According to a couple of new market research reports summarized by Healthcare IT News, U.S. providers continue to be eager EMR buyers, despite the decreasing flow of Meaningful Use incentive dollars.

On the surface, it looks like the U.S. EMR market is pretty saturated. In fact, a recent CMS survey found that more than 80% of U.S. doctors have used EMRs, spurred almost entirely by the carrot of incentive payments and coming penalties. CMS had made $30 billion in MU incentive payments as of March 2015. (Whether they truly got what they paid for is another story.)

But according to Kalorama Information, there’s still enough business to support more than 400 vendors. Though the research house expects to see vendor M&A shrink the list, analysts contend that there’s still room for new entrants in the EMR space. (Though they rightfully note that smaller vendors may not have the capital to clear the hurdles to certification, which could be a growth-killer.)

Kalorama found that EMR sales grew 10% between 2012 and 2014, driven by medical groups doing system upgrades and hospitals and physician groups buying new systems, and predicts that the U.S. EMR market will climb to $35.2 billion by 2019. Hospital EMR upgrades should move more quickly than physician practice EMR upgrades, Kalorama suggests.

Another research report suggests that the reason providers are still buying EMRs may be a preference for a different technical model. Eighty-three percent of 5,700 small and solo-practitioner medical practices reported that they are fond of cloud-based EMRs, according to Black Book Rankings.

In fact, practices seem to have fallen in love with Web-based EMRs, with 81% of practices telling Black Book that they were happy with implementation, updates, usability and ability to customize their system, according to the Q2 2015 survey. Only 13% of doctor felt their EMRs met or exceeded expectations in 2012, when cloud-based EMRs were less common.

Now, neither research firm seems to have spelled out how practices and hospitals are going to pay for all of this next-generation EMR hotness, so we might look back at the current wave of investment as the time providers got in over their head again. Even a well-capitalized, profitable health system can be brought to its knees by the cost of a major EMR upgrade, after all.

But particularly if you’re a hospital EMR vendor, it looks like news from the demand front is better than you might have expected.

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Healthcare data security is like a box of chocolates

Healthcare data security is like a box of chocolates | Healthcare and Technology news |

The Fifth Annual Benchmark Study on Privacy & Security of Healthcare Data by Ponemon Institute had more surprises than Forrest Gump’s box of chocolates – surprises that were far from palatable. One key finding was that criminal attacks are up 125 percent and are now the leading cause of healthcare data breaches. Other results of the study were just as unsettling:

Surprise 1: Sixty-five percent of healthcare organizations do not offer any protection services for patients whose information has been lost or stolen. With cyber threats on healthcare data mounting, this is unacceptable. Ironically, the Ponemon study also found that 65 percent of healthcare organizations—the same percentage that don’t offer protection services—believe patients whose records have been lost or stolen are more likely to become victims of medical identity theft.

According to the Ponemon Medical Identity Fraud Alliance study, 2014 Fifth Annual Study on Medical Identity Theft, medical identity theft nearly doubled in five years, from 1.4 million adult victims to over 2.3 million in 2014. Many medical identity theft victims report they have spent an average of almost $13,500 to restore their credit, reimburse their healthcare provider for fraudulent claims and correct inaccuracies in their health records. Healthcare organizations and business associates must make available medical identity monitoring and identity restoration services to patients whose healthcare records have been exposed.

On the other hand, the majority of people still don’t understand the serious risk of medical identity theft. They pay more attention to their credit score and financial information than they do their insurance EOBs or medical records. They don’t understand that while a credit card can be quickly and easily replaced, their medical identity can take years to be restored. When their records become polluted, patients can be misdiagnosed, mistreated, denied much needed medical services, or billed for services not rendered. Medical identity theft can literally kill you, as ID Experts CEO Bob Gregg has said.

Surprise 2: The average cost of a healthcare data breach has stayed fairly consistent over the past five years – $2.1 million. This is in contrast to the average total cost of data breach in general, which has risen 23 percent over the past two years to $3.79 million, according to another recent Ponemon report, 2015 Cost of Data Breach Study: Global Analysis. Cyber liability insurance to cover notification costs, better options for identity monitoring, and more privacy attorneys offering help should reduce the cost of healthcare data breaches over time.

Healthcare organizations can take proactive steps to reduce the likelihood and impact of a data breach. This means addressing the tactical issues of protecting patient data. According to Dr. Larry Ponemon, founder and chairman of Ponemon Institute, healthcare organizations face “the dual challenge of reducing both the insider risk and the malicious outsider. Both require different approaches that can tax even the most robust IT security budget.” 

According to the Ponemon report, 96 percent of healthcare organizations had a security incident involving lost or stolen devices, and employee negligence is the greatest concern among these organizations. Dr. Ponemon says healthcare providers should create “a more aggressive training and education awareness program, as well as invest in technologies that can safeguard patient data on mobile devices and prevent the exfiltration of sensitive information.”

These training and awareness programs should center around protecting PHI, especially education on how to avoid phishing emails and what to do to ensure data is not disclosed. Healthcare organizations must also collaborate with their business associates to also ensure they have similar programs in place. 

For external risks such as the growing number of criminal attacks, Dr. Ponemon says that healthcare providers must “assess what sensitive data needs to be monitored and protected, and the location of this data.” I would add that board and executive management must recognize that professional hackers are targeting health data and records and, as mentioned earlier, that such attacks are now the leading cause of data breaches in healthcare. This awareness should spur enterprise-wide alignment in addressing cyber threats.

Surprise 3: Too many healthcare organizations take an ad-hoc approach to incident risk assessment. Only 50 percent of healthcare organizations in the study performed the four-factor risk assessment following each security incident, as required by the HIPAA Final RuleOf that 50 percent, 34 percent used an ad hoc risk assessment process, and 27 percent used a manual process or tool that was developed internally.

This practice is not acceptable. Healthcare organizations now have software tools available to help automate and streamline processes such as risk assessment and data breach response. By supporting consistent and objective analysis of security incidents, providing a central repository for all incident information, and streamlining the documentation and reporting process, these tools can improve outcomes and free an organization’s privacy and security staff to spend more time on prevention.

So far, 2015 has been a bad year for protecting patients and their data. Increasing cyber attacks mean that even more patients and their data will be put in harm’s way. While nobody can escape the inevitable security incidents, it is my hope that we can all learn lessons from the Ponemon study and each other, and work more collectively so that next year will bring fewer unpleasant surprises and many more happy ones.

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Why Doctors Are Quitting -- And Why It's Not Obama's Fault

Why Doctors Are Quitting -- And Why It's Not Obama's Fault | Healthcare and Technology news |

In September 2009, Terry Jones wrote in Investor’s Business Dailythat the United States was barreling toward catastrophe: Nearly half the nation’s physicians were on the verge of hanging up their stethoscopes.

“Four of nine doctors, or 45%, said they ‘would consider leaving their practice or taking an early retirement’ if Congress passes the plan the Democratic majority and White House have in mind,” Jones warned.

“Projecting the poll’s finding … 360,000 doctors would consider quitting.”

Well, Congress did pass that plan six months later. (You might have heard: It’s called the Affordable Care Act.)

But our doctors didn’t go away.

In fact, rather than lose 360,000 physicians, the nation’s gained nearly 100,000 practicing doctors in the past six years.

Time and again, surveys have predicted that physicians’ anger over Obamacare, over regulations, over declining reimbursement is driving them out of the industry. That doctors’ gloom will lead to doom for American health care.

“Six in 10 physicians say that it is likely that many physicians will retire earlier than planned in the next one to three years,” Deloitte warned in 2013.

“Recent anecdotes suggest more physicians may be retiring earlier than in the past and [in] a large cohort,” the Lewin Group concluded — in 2004.

But we see again and again: Intent doesn’t equal action. At least, not on a national scale.

For instance, the Wall Street Journal in 2013 implied that doctors were leaving Medicare en masse. It wasn’t true.

Last Friday, the latest high-profile pessimist popped up — Charles Krauthammer, a Harvard Medical School-trained doctor and a columnist for the Washington Post.

In an essay carried in hundreds of newspapers, and originally called “Why Doctors Quit,” Krauthammer argued that the Obama administration has “demoralized doctors and degraded care” by pushing providers to quickly adopt electronic health records, known in shorthand as EHRs.

In Krauthammer’s telling, EHRs have turned out to be “ health care’s Solyndra” — they haven’t justified the $27 billion in incentive payments that the White House used to get doctors to go digital.

“Many, no doubt, feasted nicely on the $27 billion, but the rest is waste: money squandered, patients neglected, good physicians demoralized,” Krauthammer wrote.

The stress of EHRs is so bad that many of his Harvard classmates from 1975 are thinking about quitting medicine, Krauthammer added. He writes:

Virtually every doctor and doctors’ group I speak to cites the same litany, with particular bitterness about the EHR mandate. As another classmate wrote, “The introduction of the electronic medical record into our office has created so much more need for documentation that I can only see about three-quarters of the patients I could before, and has prompted me to seriously consider leaving for the first time.”

You may have zero sympathy for doctors, but think about the extraordinary loss to society — and maybe to you, one day — of driving away 40 years of irreplaceable clinical experience.

It’s true that doctors — especially older ones — are frustrated about the shift to electronic health records.

And understandably so! EHRs have added a burden to a busy workday. The added value of digitized data isn’t always obvious. There’s evidence they hurt productivity.

As a journalist, I’ve heard these complaints over and over again from doctors. And as a patient, I’ve witnessed doctors’ anger firsthand.

A few years ago, I was in the office of a middle-aged neurologist, one of the greatest diagnosticians I’ve ever met. It was a routine check-up, but he spent more time looking at his computer screen than at me.

“This gets in the way of patient care,” he groused, his eyes locked on the screen.

“Why don’t you hire a medical scribe?” I asked the doctor. “Someone who can keep the notes while you see patients?”

He swiveled around and scowled. “The hospital doesn’t want to pay,” he said, as his eyebrows scrunched. “I don’t know how much longer I can keep doing this.”

But that doctor didn’t go anywhere. He’s got kids in Ivy League colleges and a D.C.-area household to fund. He’s got years invested in building a practice. And walking away from that will take more than frustration over a computer system.

In fact, the real reason why doctors are quitting is less dramatic: They’re aging.

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Hospitals Should Give Smartphones To Sick Patients

Hospitals Should Give Smartphones To Sick Patients | Healthcare and Technology news |

As I see it, hospitals have developed a new and rapidly emerging problem when it comes to managing mobile health services. Not only do they face major obstacles in controlling staff use of tablets and smartphones, they’re right in the center of the growing use of these devices for health by consumer. It’s BYOD writ even larger.

Admittedly, most of the consumers who use mobile devices don’t rely that heavily on them to guard and guide their health. The healthiest of consumers may make a lot of use of wearable fitness bands, and a growing subset of consumers may occasionally leverage their phone’s video capabilities to do telemedicine consults, but few consumers base their medical lives around a mobile device.

The chronically-ill patients that do, however, are very important to the future of not only hospitals — which need to keep needless care and readmits to a minimum if they want to meet ACO goals — but also the insurance companies who finance the care.

After all, the more we dig into mHealth, the more it appears that mobile services and software can impact the cost of care for chronic conditions. Even experiments using text messages, the lightest-weight mobile technology available, have been successful at, for example, helping young women lose weight, change their diets, and slash their risk of cardiac problems. Just imagine the impact more-sophisticated technologies offering medication management, care coordination, blood glucose and pulse ox tracking could have on patients needing support.

But there’s a catch here. A long as mHealth services are delivered via the patient’s own device, the odds of successfully rolling out apps or connected health monitoring services are minimal. I’d argue that such mHealth services will only have a major impact on sick patients if the technology and apps are bolted to the hospital or clinic’s IT infrastructure.  And the operating system used by patients, be it Android or iOS, should be the same one the hospital supports among its employees, or maintaining apps, OS upgrades and patches and even firmware upgrades will be a nightmare to maintain.

Given the security and maintenance issues involved in fostering a connection between provider and patient, I’d argue that providers who are serious about advanced mHealth services absolutely must give targeted chronically-ill patients a locked-down, remote controlled smartphone or tablet (probably a smartphone for mobility) and lock out their networks from those trying to use connected apps on a rogue device.

Will this be expensive?  Sure, but it depends on how you look at costs.  For one thing, don’t you think the IT staff costs of managing access by various random devices on your network — or heaven forbid, addressing security holes they may open in your EMR — far exceed even the $700-odd retail price for such devices?

This might be a good time to get ahead of this issue. If you’re forced to play catch up later, it could cost a lot more.

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Physicians Need to Take Time for Themselves

Physicians Need to Take Time for Themselves | Healthcare and Technology news |

Doctors and their office staffs, like nearly everyone else, are living to ripe old ages. As such, they need to pace themselves for the long haul. A personal story helps illustrate the point: I worked with my friend Peter, for Smyth Manufacturing Company, the famed book binding equipment manufacturer, the summer before we entered college. It was my only time in a job shop, and I learned many lasting lessons, such as the importance of cleanliness in an industrial setting.

Before you left for the evening, you oiled your machine, wiped the floor and counters, and cleared away scraps and extraneous items so you could begin the next day without impediments. The craftsmen sometimes elaborately cleaned and reorganized items in the middle of the day as well, as they switched from one job to another. When you're working with potentially dangerous industrial equipment, you can't afford to have a stray bolt or paper clip lying around that could catch in a gear and fly across the factory floor into someone's face.

Control of their immediate environment

As deftly as these job shop professionals worked, they continually maintained control of their immediate environment because they understood its importance on many levels. In case you think they were being overly cautious or were paid some admirable hourly wage, guess again. These workers were paid by the piece, and they were known as "piece workers."

Any one of them could have easily increased their output on a given day by slacking off on cleaning and maintenance procedures. After all, if you can turn out seven pieces in a day spending 30 percent of your time cleaning and maintaining, you might be able to produce more than 10 pieces if you completely concentrate on your output. In the short-term, you could make more money. Longer term, you could injure yourself or others, create more waste, shorten the equipment's life, or get fired.

The lesson for us all: "pay as you go," clear the decks each night, arrive ready for the next day, and pace yourself for the long haul.

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The Female Physician Perspective on Healthcare Today

The Female Physician Perspective on Healthcare Today | Healthcare and Technology news |

I'm not a doctor, but I've represented their interests for more than 18 years working for a professional association of physicians from all specialties and every type of practice setting. It wasn't too long ago that the stereotypical association member was akin to the fictional Marcus Welby, MD, an elderly male private-practice physician. Times certainly have changed.

Shifting Physician Workforce Demographics

Today, there are more women in medicine than at any point in history. In fact, according to The Physicians Foundation, females comprise 33 percent of the physician workforce in the United States, a number that continues to rise as women enter medical schools in record numbers.

Responses from 20,000 physicians in a recent Physicians Foundation survey  revealed the angst many in the profession feel about the state of medicine. The survey sheds some light on changing workforce demographics and the diversity of attitudes and perspectives among America's doctors; specifically, it provides insight into the viewpoint of female physicians today.

Issues Facing Physicians Today: The Female Perspective

According to the survey, female physicians are slightly more optimistic than their male counterparts about healthcare today, yet despite this optimism, trepidation still exists among female physicians in regards to elements of reform, such as accountable care organizations (ACOs) and insurance exchanges. The survey reveals that:

• 63.9 percent of female physicians give the Affordable Care Act a passing grade, while only 49 percent of male physicians stand by the reform;

• 41 percent of female physicians are unsure about structure and purpose of ACOs, compared to 28 percent of their male counterparts; and

• A smaller percentage of female doctors participate in exchanges and more females compared to males are unsure of whether the exchanges feature a restricted network of providers.

The Changing Healthcare Landscape

All physicians today are feeling the pressure of rising costs and the plethora of new regulations as the industry moves from fee-for-service to pay-for-value. While the reform law did provide access to health insurance coverage for more Americans, it did little to ensure a stable physician workforce — a vital piece of the healthcare equation.

On the positive side, with a focus on prevention and disease management, care delivery has become more patient-centered. The Physicians Foundation survey showed that 80 percent of physicians describe patient relations as the most satisfying factor of practicing medicine.

When I started working at the Washington State Medical Association in the mid-1990s, 38 percent of our members were in solo practice; today the figure has plummeted to 8 percent. According to the survey, less than 20 percent of physicians nationwide are in solo practice, while the number of physicians in employed practice has jumped to over 50 percent. For the female demographic, 26.7 percent are in solo practice, 26 percent are employed by a medical group, and 32.5 percent are employed by a hospital.

Despite the changes and apparent anxiety in regards to the future of healthcare, 72 percent of female physicians believe that medicine is still a rewarding profession. It's clear that women will play a prominent role in helping to shape the future of healthcare.

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A Hospital Is Already Giving Apple Watch To Its Patients

A Hospital Is Already Giving Apple Watch To Its Patients | Healthcare and Technology news |

The Apple Watch began arriving in homes and businesses across America on Friday.

And in New Orleans, one doctor immediately strapped it to his patient’s wrist.

“We need to fundamentally change behavior,” says that doctor — Richard Milani. “And the Apple Watch has the potential to [do] it.”

Milani is the Chief Clinical Transformation Officer at Ochsner Health System, and overseeing what the hospital calls a first-of-its-kind trial: Giving Apple Watch to patients who struggle with high blood pressure, and seeing if it prompts them to take their medication, to make positive changes in lifestyle, and simply, to just get up and move around.

And Milani believes that the potential opportunity is huge: More than 80% of U.S. health care spending goes toward chronic disease. And many of those diseases are exceedingly preventable.

Apple Watch part of Ochsner’s broader strategy

While it doesn’t have the national profile of some health systems, Ochsner has been working hard to be a leader in digital medicine.

  • More than a year ago, the hospital launched an “O Bar” — deliberately modeled on Apple’s Genius Bar — to help patients pick through the thousands of health and wellness apps available to them.
  • Six months ago, Ochsner became the first hospital to integrate its Epic electronic health record system with Apple’s HealthKit software.
  • And in February, Ochsner launched its “Hypertension Digital Medicine Program,” a pilot program where several hundred patients regularly measure their own blood pressure and heart rate ratings using wireless cuffs, which then send that data through Apple’s HealthKit (and collects it in their medical records). Based on the results, Ochsner staff then make real-time adjustments to the patients’ medication and lifestyle.

The new Apple Watch trial builds off the hospital’s existing digital medicine program, Milani says. And he began Friday’s pilot with his longtime patient Andres Rubiano, a 54-year-old who’s spent the past twenty years trying to manage his chronic hypertension.

Rubiano says that his two months participating in Ochsner’s digital medicine program have been “comforting” — he enjoys the constant monitoring — and have already led him to make changes in diet and exercise.

“It’s been a life-changer for me,” he says.

But the Apple Watch has the potential to go further. Its customized alerts and prompts encourage immediate interventions. When we spoke on Friday afternoon, just six hours or so after he began wearing the Apple Watch, Rubiano raved about the subtle taps on his wrist.

“It’s like I have Milani as my buddy right next to me,” Rubiano said, “just nudging me to get up off your [behind] and walk around, or saying, hey, take your meds.”

Milani acknowledges there’s limited evidence that wearable technologies can directly lead to the health improvements he’s hoping to see.

But he plans to quickly enroll about two dozen patients in his Apple Watch trial, in order to begin collecting data on whether the Watch is actually making a difference. (Other patients in the hypertension program will act as the control group.) And he’s optimistic that wearable technology will pay dividends in health.

“For whatever reason, health care doesn’t do a very good job of creating [the necessary] behavior change,” Milani says. “But many of these new technologies have that ability.”

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Building Effective Patient Education Programs

Building Effective Patient Education Programs | Healthcare and Technology news |

Patient education programs have been around for a long time, but typically these programs have been geared toward only the chronically ill and those that needed extensive management. In this era of the Patient-Centered Medical Home patients and insurers are looking more to physician practices to provide effective patient education in all aspects of their care. In fact, many insurance companies are actively measuring physicians' performance on quality metrics. Current accountable care models factor in patient utilization of emergency rooms, hospital visits, and prescriptions, and attribute that cost to the patient's primary-care doctor, which may also include specialties such as cardiology.

So what does this mean to your practice? With more accountability comes the need to manage patient populations more effectively to be able to hold the line on costs. If you are not doing a good job in actively engaging patients to "self manage" their own care, and utilizing lower-cost opportunities for managing your patients' care, then you may soon find yourself failing to achieve a targeted level of care and cost utilization, and that will cost you money.

Creating and implementing effective programs

The most effective education programs are those that are customized to each patient. But don't let that daunt you. You can define general care plans and then customize those on a patient-by-patient basis.

• First, determine what conditions to tackle. Get to know your patient population. What are the most complex and costly conditions that you manage? What conditions apply to the most patients across your practice? Hone in on those areas to begin with, set up and fine-tune a program or two, and then you can replicate successful programs across your entire patient base from there.

• Second, assess your patients' needs. Determine what actual resources and help is needed by your particular patients. Do not hesitate to poll your patients by asking them directly what their specific needs and challenges for self-management may be. If you make assumptions about your patients' needs, you may only meet the goals of a small part of your population, which can be counterproductive and result in poor compliance with the program. In addition to assessing needs, assess the challenges (such as lack of family support) and skills (Internet use, reading ability etc.) of your patients and build a program that can adequately meet them where they are coming from.

• Third, use what's available. Don't reinvent the wheel. There are lots of good materials, courses, and programs available. It's OK to adopt a program you like; just make sure to thoroughly review all of the material and adjust the sections, ideas, concepts, and so forth to fit with your specific patients' needs and your style of practicing medicine.

• Fourth, communicate effectively and set small targets. Let your patients know about these programs and educate them about what they are expected to do. Priorities should be clearly stated, mutually understood, and mutually agreed upon, and patients should be provided with information about what to do if they go "off the plan." That will help to keep them empowered and engaged in their own care, and keep them communicating effectively with you and the office when there is a problem. Keep the goals small and manageable to begin with and don't overload the patient with information. Tip sheets and goal targets should be the core of the program; then add in more information as the patient progresses. Keeping material simple, clear, and to the point will help with comprehension.

Setting one target per visit is a manageable way for patients to begin working a program. For example, set a new diabetes patient the goal of reducing his intake of sweets to three desserts per week, and provide a cheat sheet of desserts that are diabetes-friendly to choose from on the plan. At the next visit, you identify a new goal to add to the first one, and repeat. While it may take a while to turn a patient's health around, research confirms that small, incremental changes are much more likely to be lasting changes, so think in terms of a marathon rather than a sprint to the finish line.

Lastly, make the plans, goals, materials, and office staff highly available to the patient. Post the educational material on your site, mail follow-up materials to patients, place outbound follow-up calls and/or e-mails to patients to check on how they are doing between visits. These touch points matter and can be the difference between a successful program and good patient engagement or wasted effort and time.

And don't forget, as of January 2015, you can now bill a monthly, per patient code for chronic care coordination, CPT 99490. Just make sure to check the guidelines for this code to adhere to the description of services before you bill it.

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A Potential Change to Stark Regs. Affecting Docs

A Potential Change to Stark Regs. Affecting Docs | Healthcare and Technology news |

On July 8, 2015, CMS issued the proposed 2016 Physician Fee Schedule (“Proposed Rule”), which was published in the Federal Register one week later.  Among many provisions within the proposed rule were ones that could possibly impact the physician self-referral regulations (“Stark”). This included the following:

• Recruiting advanced practitioners may become easier under CMS’ proposal to establish a new Stark exception for payments made by a hospital, Federally Qualified Health Center (“FQHC”), or Rural Health Center (“RHC”) to a physician to assist in the recruitment and employment of non-physicians.  This would allow the recruitment of PAs, NPs, and other mid-levels, as long as they become bona fide employees of the physician or physician practice receiving the support and if they are employed to render primary care services. CMS’ proposal would limit the financial support to two years, but the exception would otherwise be similar to the current recruitment exception.

• Easing technical issues and confusion is another goal of the Proposed Rule’s changes to Stark, particularly as it relates to CMS’ Voluntary Self-Referral Disclosure Protocol. Some clarifications that are proposed, which will be beneficial to providers include:

  a. Clarifying that a “writing” or “written agreement” does not actually require a single formal contract. This means that a series of contemporaneous documents that could demonstrate the course of the parties’ conduct could meet this “writing” requirement, depending on the facts.

  b. Providing 90 days (instead of the current 30 days) to obtain missing signatures to an agreement, regardless of the reason the parties failed to obtain the signatures in a timely manner.

c. Allowing a holdover arrangement as long as it continues on the same terms and conditions as the original compliant arrangement and payment remains fair-market value throughout the holdover period.

• CMS proposes to allow timeshare leases under a new exception for lease arrangements involving the non-exclusive “timeshare” lease of space, equipment and personnel.  Arrangements would qualify if certain requirements are satisfied, and as long as the arrangement does not involve advanced imaging equipment, radiation therapy equipment, or clinical /pathology laboratory equipment. This exception would not be available to non-hospital/ physician organizations (such as IDTFs and clinical labs) and the space must be used predominantly.

One other non-Stark item in the Proposed Rule that may be particularly interesting to physicians is a change to the “incident to rules.” These  provisions allow services provided by auxiliary personnel to be billed as though furnished by a physician or other provider if direct supervision is provided (except chronic and transitional care management, which now requires only general supervision).  Although many physicians already grapple with proper use of these rules, CMS now proposes to require “that the physician or other practitioner who bills for ‘incident to’ services must also be the physician or other practitioner who directly supervises the auxiliary personnel who provide the ‘incident to service.’”  

Under the current regulations, the billing physician or other practitioner need not be the supervising physician or other practitioner.  This rule may complicate scheduling among providers and make the provision of transitional care management and chronic care management less cost-effective, since these services currently only require general supervision. Furthermore, the proposed changes are not in keeping with efforts to reduce health care costs and increase efficiencies.

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Digital health venture cash keeps pace with 2014

Digital health venture cash keeps pace with 2014 | Healthcare and Technology news |

Venture capital for the digital health market is still holding its own, keeping pace with last year's "record-breaking growth," according to a new report from digital health startup accelerator Rock Health.

In fact, this year's Q2 raked in $2.1 billion from investors for digital health startups, just shy of last year's mid-year number which reached $2.3 billion.

"Now at the half-year mark, investors have spoken," wrote Malay Gandhi, managing director at Rock Health, in a July 6 post, unveiling the numbers. "Digital health isn't slowing down."

Although the number of deals were fewer than last year at this time – 139 deals in 2015 compared to 146 in 2014 – the average deal size was $400,000 bigger this time around.

One of the big changes this year was around the most funded digital health category. Last year, the winner was payer administration startups, which collectively scored $211 million. This year, wearables and biosensing companies walked away with the lion's share of funding, at $387 million. However, San Francisco-based wearable company Jawbone accounted for $300 million of that pie.

Analytics and big data came in at No. 2 for most funded digital health category, bringing in $212 million by mid 2015. That represents a $16 million increase in this category from last year's numbers. Salt Lake City-based analytics startup Health Catalyst brought in $70 million.

According to another digital health accelerator StartUp Health's mid-year report, however, analytics and big data came in third place, below wellness/benefits and patient/consumer experience. The company bills itself as the world's largest portfolio of digital health companies. 

One category in Rock Health's report that failed to emerge as top theme last year – EHR and clinical workflow – brought in $74 million this time around. One of those startups, the San Francisco-based Augmedix, which integrates Google Glass with the electronic medical record, earned $16 million of that.

This year, Rock Health officials also tracked digital health IPOs, which "outperformed" S&P 500 by the end of Q2.

"Coming off a record-smashing year for digital health funding, where dollars into the space totaled more than 8 percent of all venture funding, it would not have been surprising if 2015 was a letdown," Rock Health officials wrote in the 2015 mid-year report. "However, 2015 has more or less kept pace with 2014."

But this growth, as they explained, also comes with a drawback. And that's "noise." In other words, it's a tough, saturated market, with a record number of digital health companies "vying for the attention of both the industry and the consumer."

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Five Reasons the Future for Private Practice Is Bright

Five Reasons the Future for Private Practice Is Bright | Healthcare and Technology news |

I believe the future remains bright for private practice. While market indicators a few years ago were interpreted by many in the industry as signaling the demise of private practice, more recent data suggests the move away from private practice has not only leveled off, but may move back toward more independence.

Here are five reasons why private practice will remain healthy for the foreseeable future:

1. The trend of hospitals buying physician practices is not as strong as it once was.

While it's true that hospitals and integrated delivery systems have purchased physician practices since well before Congress passed the Affordable Care Act in 2010, some hospitals also have lost money on these acquisitions. Some say the losses total as much as $100,000 per physician, per year. Also, some physicians are not happy being employed by these larger systems.

2. New practice models help physicians stay independent.

Patient-Centered Medical Homes, for example, allow physicians to organize care to meet patients' needs in a way that was not possible in the past. Recognizing that the center-of-care has shifted to patients, providers and insurers are investing in systems to meet patients' needs and boost patient satisfaction scores. One reason for this shift has been the focus on delivering more preventive care under the ACA, a factor aimed at keeping patients well rather than simply treating them when they're ill. And patients want to keep their doctors, meaning they'll follow them wherever they go.

3. Accountable care organizations (ACO) are another option for physicians seeking to remain independent.

Physicians can contract with ACOs or do as some large physician groups have done and form their own ACOs. Either way, these organizations allow physicians to stay in private practice while focusing on improving care. Some ACOs offer shared-savings contracts that let physicians reap the benefits if they keep costs below a target amount calculated at year's end.

4. Health insurers are emerging as physician partners.

In the recent past, health insurers have not had much of an opportunity to affect whether a doctor or physician group sells out to a hospital. But since the ACA became law, health plans have changed how they pay physicians to support the transition from volume-based reimbursement to value-based care. Developing financial incentive programs to get doctors to focus on keeping costs down and quality up have taught health insurers that physicians can and should be considered partners in care delivery.

5. Health plans also recognize that physicians deliver care in low-cost settings.

Hospitals and health systems are much more expensive sites of care. The fact that physicians keep costs down is perhaps the most critical success factor for any health plan or health system. Cost has always been the most important factor for individuals buying insurance plans on the health insurance exchanges and for employers buying health insurance for their workers and family members.

For all these reasons, I believe physicians have a large and maybe even a growing role to play in any reformed health system. Of course things have and continue to drastically change for physicians today, but it's safe to say the sky is not falling for those in private practice.

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Providers Looking for More out of HIEs

Providers Looking for More out of HIEs | Healthcare and Technology news |

Healthcare providers’ health information exchange (HIE) needs have moved beyond connecting disparate systems and meeting meaningful requirements. They are now looking for HIEs to ease access to “actionable” data, according to a report from NORC at the University of Chicago.

The researchers conducted an in-depth examination consisting of site visits and 37 semi-structured discussions in six states (Iowa, Mississippi, New Hampshire, Utah, Vermont, and Wyoming) in the early months of 2014 to understand provider perspectives on the state HIE program and their experiences with electronic exchange. The report was funded by the Office of the National Coordinator for Health Information Technology (ONC).

The report found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination. Providers highlighted several exchange priorities: admission, discharge, transfer (ADT) alerts, services that facilitate care coordination, and interstate exchange.

Additionally, meaningful use and payment reform are creating new requirements for health IT-enabled information sharing related to care coordination and management as well as new models for patient care. Providers anticipate a growing need for vendor provided HIE services and infrastructure as expectations for electronic exchange of health information increase under this shift, the report found.

Providers also encountered various challenges, specifically competing priorities, issues managing multiple funding streams, lack of qualified staff on the provider side, and difficulty obtaining adequate support from electronic health record (EHR) and HIE vendors. They also noted a need for interoperable systems to meet exchange and health system reform goals.

What’s more, providers in most states believed that the state HIE program contributed to building awareness around HIE and the benefits of exchanging information. Providers conveyed a general sentiment that a state-based HIE effort is important, due to their stature as neutral entity, capable of bringing stakeholders together. Even though the meaningful use program did not provide incentive payments to long-term care and behavioral health providers, the state HIE program was instrumental in engaging these providers, identifying their specific needs and the gaps that grantees needed to fill, particularly around care continuity, the report revealed.

The researchers concluded, “Throughout the life of the program, HIE has become more visible and better established, meaning that provider priorities and challenges have likewise evolved.” In addition to highlighting providers’ current needs and perspectives on HIE, findings from these conversations emphasize certain areas, the researchers said:

  • Providers have additional use cases beyond meaningful use and payment reform they are or would like to pursue to meet their specific exchange needs.
  • New healthcare system priorities, such as care coordination suggest expanding interoperable health IT systems and services to providers in eligible for meaningful use to ensure that the information needed to manage care is available electronically.
  • There is a need to push for interoperability at the vendor level.
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Preventing Physician Burnout

Preventing Physician Burnout | Healthcare and Technology news |

In a cross-sectional survey ("Predictors of physician career satisfaction, work-life balance, and burnout," Obstetrics & Gynecology) of randomly selected physicians from across the country just under half of all respondents indicated that they were satisfied with their work-life balance, and half of respondents indicated that they felt some level of emotional "resilience." It turns out that the lack of these two factors plays a significant role in the development of physician burnout; a syndrome that occurs when a person is under constant pressure, and is marked by emotional exhaustion, cynicism, feeling ineffective in one's work, and experiencing interpersonal difficulties. Burnout in physicians, which has been on the rise, has been linked to impaired job performance, poor health, marital difficulties, and alcohol or substance abuse.

The good news is that there are strategies that can be taken to significantly reduce the incidence and negative effects of burnout. Factors that are critical to combating burnout are having control over one's schedulethe number of hours worked, and emotional resilience. Unfortunately, in this current era of healthcare reform, controlling the first two factors can be quite challenging, but not impossible, if one takes a conscious and deliberate approach to managing priorities and time. Many physicians find that they spend a significant amount of time on activities that do not provide enough value — one way to think about this is to determine your "time ROI" (return on investment).

Follow these five steps to significantly improve your work-life imbalance:

1. Identify the five to eight most important aspects of your life (what you value most).

2. Now determine how much time you devote to those areas (and how much time is spent in areas not on your list).

3. If there is a disconnect between what you value and how you spend your time, this is a signal to you to make changes in your life.

4. Plan your time so that you are focused on what you value most.

5. Determine what can be delegated to others.

Preventing burnout also involves developing emotional resilience — the ability to manage stressful situations effectively and prevent stress from building up. For this we turn to some interesting research from the field of neuroscience that explores the link between stress, sleep, and positivity. These three factors have an interdependent relationship with one another — cause a change in one, and the other two are impacted.

So for example, the more stress in your life, the worse your sleep and mood. If you get too little sleep, then you will experience more stress and a lowered mood. In general, it can be difficult to derive meaningful change in the first two factors, sleep and stress, but much easier to have an impact on the latter one — positivity. If you are able to increase positivity, you will experience a significant improvement in sleep and a significant reduction in stress (negative emotional state).

Follow these simple brain-training steps to increase your positivity:

1. Practice positive "self-talk" by cultivating self-encouragement optimism, recognizing accomplishments, and appreciating good fortune.

2. Challenge your negative (typically distorted) thinking, the most common of which are:

• Catastrophic thinking. Identify a more realistic assessment of the situation. Usually, things are not as bad as we think they are. And often, our greatest learning comes from adversity.

• Black and white thinking. Challenge all-or-nothing thinking. Usually there is some gray area to work with. It is very seldom absolute.

• Jumping to conclusions. Avoid leaping to a foregone conclusion, such as thinking you know what others must be thinking. Learn to get curious, ask questions, and look for alternative explanations.

• Over generalizing. Look for a more accurate appraisal of the situation. When we look more closely at situations, we often find that negative or stressful outcomes are limited to that event, not generalizable across all situations.

• Excessive criticism. Whenever you hear yourself thinking, "should," substitute "it would be nice." This allows you to avoid excessive self-criticism or the belief that there is only one solution.

Changing thinking leads to changes in behaviors which leads to changes in results. So the easiest and most efficient method to change the results you are getting is to engage in positive and constructive thought patterns. As you transform your thoughts, you actually create an alteration in the neural connections in your brain. This in turn, leads to the development of new habits, ensuring that the changes you create are lasting ones.

Dan Diamond, MD's curator insight, June 12, 2015 2:16 PM

I also suggest that people have a team of at least 10 people that will encourage and challenge them. If you team is too small, it is easy to burn them out. Write the name of your ten on paper and post it on the back of your medicine cabinet. Reconnect, stay connected.!

HIMSS15 Provides Both Clarity Confusion

HIMSS15 Provides Both Clarity Confusion | Healthcare and Technology news |

For the first time since 2009, the HIMSS Annual Conference & Exhibition was back in its hometown of Chicago this year. And, with more than 43,000 attendees and 1,200 exhibiting vendors flocking to McCormick Place Convention Center, this proved to be the largest HIMSS conference on record. Many of the same pressing topics from HIMSS14 were prevalent again at this year’s event — namely interoperability and population health management.

A Step Forward For Interoperability

Interoperability continues to be one of the biggest challenges facing the health IT industry. And, thankfully, HIMSS15 actually seemed to provide some much needed direction in this area as opposed to just rhetoric.

For example, HIMSS15 provided one of the biggest venues for health IT industry leaders to sit down with members of the ONC to discuss the nationwide Interoperability Roadmap that was drafted earlier this year. This roadmap charts a path for the health IT industry to achieve interoperability progress in 3, 6, and 10 years using core critical building blocks identified by the ONC.

The ONC even organized several listening sessions dedicated to fostering industry collaboration on the Roadmap. One, titled Advancing Interoperability and Standards, was open to all HIMSS attendees and aimed to answer questions, provide clarity, and set realistic expectations surrounding the Roadmap. Another, titled ONC Interoperability Listening Session With Health IT Developers, was specifically designed for the software developer community to discuss the unique challenges and opportunities associated with developing an interoperable infrastructure for health IT. Yet another ONC interoperability listening session targeted clinicians in an effort to gain a better understanding of their interoperability demands.

The ONC’s take on interoperability was summed up well by the organization’s National Coordinator Karen DeSalvo, MD during her keynote on Thursday morning.  During her speech, DeSalvo referenced that she participated in dozens of similar interoperability listening sessions throughout the year and she believes the path to health IT interoperability hinges on three primary objectives:

  1. Creating standardized standards, including APIs;
  2. Improving clarity regarding the trust environment, particularly data security and privacy; and
  3. Establishing sustainable and durable incentives that promote interoperability and appropriate use of health information between systems.

Finally, HIMSS15 once again featured an Interoperability Showcase, where more than 50 sponsoring vendors offered first-hand demonstrations as to how their technologies could be leveraged to deliver health IT interoperability in a variety of care settings. This year’s Interoperability Showcase was the largest landmark on the exhibit floor and provided visitors with real-world insight into how interoperability can be achieved.

A Muddled Population Health Management Message

While HIMSS15 did an admirable job of attempting to clarify the interoperability dilemma facing health IT and the go-forward strategy, I believe it had the opposite effect in regards to Population Health Management (PHM). PHM was one of the biggest buzzwords at HIMSS15. Just about every other vendor on the exhibit floor promoted how its product or service was instrumental in the PHM equation. I can’t help but think that all of this noise was confusing to the providers in attendance searching for an effective PHM solution.

From my perspective, HIMSS15 clearly illustrated the clear need for a universally accepted definition for PHM in the health IT industry. I must have spoken to executives from more than a dozen self-proclaimed PHM vendors at HIMSS, and I never heard the term defined the same way twice.

Rather than simply complain about the lack of an agreed upon PHM definition, I thought I might take a crack at getting the ball rolling toward this end. Based on my conversations at HIMSS and my editorial coverage on PHM to date, a true PHM initiative must include the following key elements:

  1. It must incorporate data aggregation from multiple sources;
  2. It must include the analytics technology necessary to turn that aggregated data into actionable intelligence;
  3. It must provide workflow tools to facilitate/automate case management and care coordination; and
  4. It must deliver mechanisms for patient engagement and feedback.

In my opinion, if a vendor product or service doesn’t address all four of these areas, then it only solves part of the equation, and isn’t a true PHM solution. While I doubt the list of criteria outlined above is the universal PHM definition the industry needs, I believe these elements provide the building blocks upon which that definition can be based. What factors am I missing? How can we round out this rough skeleton to create an accurate PHM definition that clarifies the concept as opposed to leaving it up to multiple interpretations? I’d be interested in your thoughts and feedback.  

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So what is interoperability anyway?

So what is interoperability anyway? | Healthcare and Technology news |

One of my most memorable experiences as an IT leader was working with with a dissatisfied customer. I asked what requirements were unmet, what features were priorities, and what future state was desired. The answer was “I’m not sure, but I know I’m not getting what I need”.

The use of the term interoperability is being tossed around in ways that makes it seem like the test for obscenity used by Supreme Court Justice Potter Stewart in 1964 when he wrote “I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description ["hard-core pornography"], and perhaps I could never succeed in intelligibly doing so. But I know it when I see it…”

Congress is angry about the lack of interoperability. What does that mean?

House and Senate stakeholders believe that vendors enjoyed a government funded windfall yet are building proprietary networks. They have heard that vendors are blocking information sharing by charging significant interface fees and thatHITECH distributed $30 billion with minimal requirements for information sharing. Many in the House feel after all this investment, the country is not prepared for new payment models. 

Some in the House have stated that Americans can communicate because "we speak English" so interoperability is about picking a common language.

Senate HELP Committee Chairman Lamar Alexander plans to take up this issue, working closely with Ranking Member Senator Patty Murray through a bipartisan effort over the coming months. 

So what is the real issue causing providers anxiety and resulting in Congress wanting to take action?

Providers are fed up with interface fees and at how hard it is to accomplish the workflow required by Accountable Carebusiness models including care management and population health. They are unsatisfied with the kind of summaries we’re exchanging today which are often lengthy, missing clinical narrative and hard to incorporate/reconcile with existing records.

All these things are true.

So what is our next step to help providers do their job and improve satisfaction to the point that Congress no longer wants to legislate the solution to the problem?

I think we all have to step back, carefully define the requirements for care coordination and care management in an ACOworld and admit that the Meaningful Use regulations did not address those requirements. We should allow the private sector initiatives already in progress (Argonaut, Commonwell, eHealthExchange) to address these market needs in collaboration with vendors, entrepreneurs, and innovators. The economic incentives of the Affordable Care Act and the Sustainable Growth Rate fix will result in hospitals and professionals demanding different kinds of technology than was prescribed in regulation.

The role for Congress should be to hold us accountable for the outcomes we want to achieve.

At a recent AMIA presentation in Boston, Zak Kohane, Ken Mandl and I were asked to be provocative -- to go rogue.

I suggested that the Meaningful Use program should be eliminated. Yes, there should be merit-based incentives for achieving stretch goals, but those can be created in another CMS program. Meaningful Use is no longer necessary. 

ONC should focus on the 5 enablers I’ve written about:

1.  Facilitating the creation of a national provider directory for message routing

2.   Encouraging the adoption of a voluntary national identifier for healthcare

3.  Providing guidance to streamline the heterogeneous patchwork of state privacy laws that are impeding information exchange

4.  Serve as the coordinating body for aligning federal government health IT priorities

5.  Supporting private sector initiatives such as Argonaut that are simplifying the tools for health information exchange

It's not a problem of "language". We have the terminologies we need, already included in certified EHRs. We have standards for content and transport, again written into certification requirements. So what's the gap? We need to make the standards better, and build interoperability into EHR workflow. That doesn't require top-down regulation, it takes the kind of goal-oriented interaction between providers, developers, and standards bodies that characterizes efforts like the Argonaut Project.

No more regulation, no more legislation. Those will only crush innovation.

Instead of saying we need interoperability, the conversation needs to include a crisp set of requirements for care management and care coordination with defined metrics of success, supported by government enablers, and accelerated with the economic incentives provided by new reimbursement models.

To paraphrase Justice Potter, if patients and providers are happier, I’ll know it when I see it.

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Medicare paid doctors $90 billion in 2013, up 17 percent: officials

Medicare paid doctors $90 billion in 2013, up 17 percent: officials | Healthcare and Technology news |

Medicare, the government-run health insurance program for elderly and disabled Americans, paid physicians $90 billion in 2013, up 17 percent from $77 billion in 2012, U.S. healthcare officials reported on Monday.

Physician payments accounted for less than one-fifth of Medicare's 2013 net outlays of $492 billion, which rose from $466 billion in 2012. Payments to hospitals for the top 100 inpatient stays cost Medicare $62 billion in 2013, while the rest went for drugs, privately run Medicare Advantage plans and other program costs.

The payments went to about 950,000 doctors, nurse practitioners and other individual healthcare providers who participate in the program. That was up from 880,000 providers in 2012.

The hospital data offer a glimpse of what ails America's elderly - and the quality shortfalls in U.S. healthcare.

The single-greatest hospital expense was to replace knees, hips and other joints in 446,148 operations, with $6.6 billion paid to hospitals.

The second-greatest hospital payment, $5.6 billion, went for 398,004 cases of septicemia, or blood poisoning, often a sign of poor in-patient care.

In a significant change from the data released last year, the Center for Medicare and Medicaid Services differentiated between what it paid physicians for their services and what it paid to cover the costs of drugs they administered. Some physicians had complained that they were portrayed as exorbitant billers because the cost of drugs was included in what Medicare paid them.

Among physicians, the highest-paid specialists were radiation oncologists, who received an average of $403,512 from Medicare for their services. That was closely followed by dermatologists ($331,108), vascular surgeons ($329,874), and ophthalmologists ($326,621).

In contrast, medical oncologists, who treat cancer patients with chemotherapy and generally coordinate their care, received an average of $181,747. The previous year's data portrayed them as some of the top Medicare billers, but that largely reflected reimbursements for the cost of drugs - an average $473,926 in 2013.

The data showed that patients who lament how little time they get with their physicians are not imagining it. Dermatologists billed for the most office visits lasting only five or 10 minutes (nearly 30 percent of total visits), whereas oncologists had almost no visits that short.

Medicare patients averaged six physician visits in 2013, but that varied significantly by state. Patients in New York, New Jersey, Florida, and Tennessee saw their doctors nearly seven times that year; those in northern New England, the Dakotas, Idaho, Montana, and New Mexico averaged fewer than four visits.

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Son's ICD-10 Software Helps Save Dad's Solo Practice

Son's ICD-10 Software Helps Save Dad's Solo Practice | Healthcare and Technology news |

Nitin Desai has the kind of medical practice you don't see much anymore. Desai, an internist, is the only physician in the practice in Columbus, Ga. His patients are like family; they know the staff personally and even have the doctor's cell phone number. Desai's wife, Bhavna Desai, is the practice manager, and his sons, Parth and Koosh, grew up in and around the practice, cutting the grass, helping out in the office, and developing a love for the practice of medicine that would led them both to medical school.

Sadly, increasing regulations and requirements for health information technology are making it more and more difficult to keep this kind of practice afloat. "I was under a lot of pressure to sell out to a hospital or join a group of other doctors," said Desai. "It is seriously hard to maintain a solo practice these days." Coming so soon after installing an EHR, the requirement to switch to ICD-10 was the last straw for Desai. Running a medical practice as a family business just didn't seem possible any longer.

Parth Desai, a first-year student at Mercer University School of Medicine in Macon, Ga., learned early about the business side of medicine. When he was just 16, health problems forced his mother to take a break from her duties as office manager. Parth stepped in to help out. His computer skills came in very handy, since neither of his parents is very computer savvy. When Parth heard about the ICD-10 transition, he knew that he could help with that, too.

Parth and his best friend, Will Pattiz, a computer programmer with experience developing training platforms and e-learning courses, built software that creates ICD-chart templates and converts codes from ICD-9 to ICD-10. For the 70 percent of codes that have one-to-one matching, conversion requires little more than the click of a button. For the 30 percent that are more complex, "You can go through and edit, fill in the codes you use, and customize as you go," Parth explained.

The pair's "ICD-10 Charts" software is quite valuable, with many practices seeking an easy way to convert to the new coding system. But Parth isn't aiming to make money from his software; he just wants to help his dad. "Dad has always helped me," he says simply.

One lesson Parth did not miss growing up in the heart of a community-focused medical practice was the imperative to help others. Parth and Pattiz have made the software available free on the Web [at] for anyone who can use it. In addition, the Physicians Foundation, a nonprofit organization dedicated to advancing the work of physicians practices, has stepped in to fund the project. With the foundation's support, additional free resources, including free coding training, will be available soon. "The Physicians Foundation is also helping us spread ICD-10 Charts throughout the country so that the project can benefit as many struggling practices as possible," said Parth.

Meanwhile back home, Nitin Desai says his son's software has made a noticeable difference in his practice's bottom line. "We're okay for now." And in the long run? "The chances are very high," says Desai, "that the boys will come home and join the practice."

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Apple Watch Changes the Health Wearables Game

Apple Watch Changes the Health Wearables Game | Healthcare and Technology news |

After months of speculation and hype, the Apple Watch has finally arrived. 

What are some first impressions? How does it compare with other watches, bands and wearables? How will it impact the digital health landscape? (By the way, if you are reading this review for information on how to deliver your one-way banner ads brand messages via Apple Watch, you're already missing the point.)

I have been an avid user of wearable fitness and health trackers for a few years. After losing several Nike FuelBands on the soccer field, I recently switched to the Microsoft Band. Although it's slightly bulky, I truly enjoy the simple interface for tracking my activities, instantly measuring my heart rate and even paying for my Starbucks coffee.

Then along comes the Apple Watch. Of course it's got a great design, but it's not going to be for everyone initially. The learning curve is steep, especially if you're like me and don't take advantage of the online or in-store training. It does have a limited battery life and seems to be missing some core health functions. It might not be ideal for people with poor vision, and it doesn't currently have independent GPS capability. I was particularly worried about whether I could wear it while playing soccer, but I simply placed a wristband over it. Voila! I didn't find a default sleep-measurement function, but I assume that there will be apps to do that. Maybe Apple would rather I charge my watch while I sleep.

It's been only a few days, but I can already say that the Apple Watch experience is a great improvement over my other fitness bands. In addition to tracking my heart rate and how much I'm moving or sitting, the Apple Watch lets me do everyday things like receive texts and email, take phone calls and use Apple Pay. But I'm most excited about how it and other wearables will help me modify my behavior for better health. There's something very motivating about receiving visual and sensory cues from a device attached to your body. For instance, the Apple Watch gives you a nudge every hour to get up and move for a minute. It's very subtle and it may be a minuscule benefit, but it can be a great tool to combat the 21st century “disease of sitting” that so many of us are facing. 

We have been talking about big data, value beyond the pill and behavioral economics for some time. 

These wearable devices provide a great opportunity to do more than simply be shiny objects for early adopters. Wearables aren't just for fitness—they can make a big impact on adherence, compliance and cessation of unhealthy behaviors. 

Two hospital systems are currently conducting digital medicine trials using the Apple Watch to help manage hypertension and to determine how nurses and physicians can benefit from incorporating the Apple Watch into a medical home program. There are already a number of industry-related apps available for Apple Watch, including those from Drchrono, Lark, Doximity, WebMD, HealthTap and others.

The uptake has been rapid: Consider the fact more Apple Watches were sold in one day than Android Wear devices in an entire year. As a digital marketer, don't expect every demographic to immediately adopt the Apple Watch or other wearables. But ignore the Apple Watch effect at your own risk. The impact of this new technology and interface will manifest over time, just like our mobile phones did. 

Remember when they said social media was only a fad?

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As sensors shrink, watch as 'wearables' disappear

As sensors shrink, watch as 'wearables' disappear | Healthcare and Technology news |

Forget 'wearables', and even 'hearables'. The next big thing in mobile devices: 'disappearables'.

Even as the new Apple Watch piques consumer interest in wrist-worn devices, the pace of innovation and the tumbling cost, and size, of components will make wearables smaller - so small, some in the industry say, that no one will see them.

Within five years, wearables like the Watch could be overtaken by hearables - devices with tiny chips and sensors that can fit inside your ear. They, in turn, could be superseded by disappearables - technology tucked inside your clothing, or even inside your body.

"In five years, when we look back, everything we see (now) will absolutely be classified as toys, as the first very basic steps of getting this right," says Nikolaj Hviid, the man behind smart earbuds called the Dash.

Developed by Munich-based Bragi GmbH, the Dash is a wireless in-ear headphone that looks like a discreet hearing aid. Packed inside is a music player, 4 gigabytes of storage, a microphone to take phone calls - just nod your head to accept - and sensors that monitor your position, heart rate and body temperature.

Nick Hunn, a consultant who lays claim to the term 'hearables', reckons the Dash is just the start. He predicts smartwatches will dominate wearable sales for the next three years, hearables will then overtake and, by 2020, will account for more than half of a $30 billion wearable device market.

This rapid shift is being driven, he says, by a new generation of chipsets using Bluetooth wireless communication and using far less power than their predecessors. Designers now realize "the ear has potential beyond listening to music - it's an ideal site for measuring a variety of vital signs," Hunn wrote in a recent report.


A parallel revolution in sensors is making this possible.

Kow Ping, whose Hong Kong company Well Being Digital Ltd provides algorithms and reference designs on wearable sensing to companies like Philips, Motorola, Haier and Parrot, says chipmakers have invested heavily in reducing the power consumption and size of sensors.

An accelerometer, which measures things like position, motion and orientation, for example, is now 1 square millimeter. "A few years ago," he says, "it was two or three times as big and two or three times less refined."

When they can harvest energy from the body's heat or motion they'll be even smaller, autonomous and ubiquitous.

Andrew Sheehy of Generator Research calculates that, for example, the heat in a human eyeball could power a 5 milliwatt transmitter - more than enough, he says, to power a connection from a smart contact lens to a smartphone or other controlling device.

And Ping's company is working with a top Asian university to add sensors to a sports bra which could harvest energy from relative motion. In five years, he says, "there will be people building sensors into every existing wearable device or apparel."


Bragi's Hviid calls these 'disappearables'. And while medical and fitness top the list of what these devices might measure, he and others are looking beyond that. A dozen sensors in your pants, he suggests, could advise on how to improve your posture or gait when trying to impress a suitor.

"It's more like a butler ... they do some basic stuff that you really want, but there are deeper experiences in there," Hviid says.

Sheehy points beyond the personal, as parallel advances in machine learning and artificial intelligence "come together and lead to some remarkable use cases:" a politician's contact lens, for example, might provide real-time feedback from a sample of voters, allowing for a speech to be tweaked on the fly.

A lot of this technology is already here.

Google is working with Novartis on a contact lens to measure glucose levels in tears. The healthcare group has also invested in Proteus Digital Health, a biotech start-up which promises edible embedded microchips, the size of a grain of sand, which are powered by stomach juices and transmit data via Bluetooth.

"We're looking at a major technological revolution of a similar magnitude to the mobile revolution," says Sheehy.


Not everyone agrees that disappearables are necessarily just around the corner. Wearables still need to gain widespread acceptance - remember Google Glass - and the technology still needs to finessed.

While Bragi has raised more than $3 million from crowdfunding website Kickstarter and another $10 million from angel investors, Hviid says communication problems between the left and right earbuds have delayed launch of the Dash until September. It was originally due out late last year.

Ping's company has been working since 2006 on wearables, and owns more than a dozen patents, but he says bringing all the technical parts together, understanding the consumer and mastering manufacturing pose a real challenge.

BAM Labs's curator insight, May 21, 2015 3:58 PM

And under the mattress, turn any bed into a smart bed.!

Young physicians see promise for fully connected health ecosystem

Young physicians see promise for fully connected health ecosystem | Healthcare and Technology news |

Physicians under the age of 40 are more likely to believe the industry will reach a fully connected technology environment soon, while those older than 40 think that move is at least five years away, according to a surveyby MedData Point.

Of the 171 physicians responding to the survey, 61 percent older than 40 feel a connected environment won't happen until 2020 or later. Sixty-seven percent under the age of 40 said it would happen in the next one to five years.

Other findings the report uncovered include the following:

  • Two-thirds say costs is the biggest barrier to connected health, with 100 percent of dermatologists listing it as the No. 1 issue
  • Forty percent say they are closest to adopting patient portals, with 51 percent of large practices but only 27 percent of small practices saying they will adopt patient portals soon. Patients increasingly look for healthcare providers that offer digital services.
  • Only 29 percent say they are close to adopting interoperable electronic health records. However, interoperability is healthcare's biggest goal currently, and glimmers of hope are on the horizon, writes FierceHealthIT Senior Editor Dan Bowman.

Barriers created by high costs may be shrinking. The confidence of health IT leaders is growing regarding their ability to meet business demands, according to a new survey by Hanover, Maryland-based TEKsystems, a provider of IT staffing solutions. In its survey of CIOs and other health IT execs, 51 percent of respondents said they expect their organization's healthcare IT budget to increase in 2015, down from 68 percent who said so a year ago.

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