Physician Practices Increasingly Accepting HIEs, Retooling EHRs

Nearly half of physician practices plan to join a health information exchange, while more than one-third of practices plan to purchase a new electronic health record system, or replace or upgrade their existing EHR system, according to a study by HIMSS Analytics, InformationWeek reports.

For the study, HIMSS Analytics -- the research arm of the Healthcare Information and Management Systems Society -- surveyed 846 physician practices.

Health Information Exchange Findings

Of the 46% physician practices that said they plan to join an HIE:

• 19% preferred a state-run HIE;
• 16% preferred an exchange connected to a hospital or health care system; and
• 11% preferred a regional exchange.

About 37% of respondents said they do not plan to join an HIE, while 17% already belong to an exchange or were unsure about joining one.

Hospital-owned groups were more likely than privately owned practices to join an exchange, with 62% of hospital-owned groups planning to join, compared with 39% of private practices.

EHR Findings

The study also found that one-third of practices plan to replace, upgrade or purchase a new EHR system.

Drivers of EHR purchases varied among practices. For example,  35% of physician groups with more than 100 doctors reported that the ability to exchange patient data among facilities was the biggest driver, compared with 17% of all practices.

Meanwhile, increasing efficiency was the biggest drive for practices with three to 10 doctors (Terry, InformationWeek, 6/6).

Comments

Brendan FitzGerald, research director of HIMSS Analytics, said the study found a "high [EHR] adoption rate across not only hospital-owned but free-standing physician practices as well," adding, "That's a positive for the industry."

In addition, "[a]s we get further down the road of meeting meaningful use ... more and more folks are leaning toward joining a health information exchange," FitzGerald said.

He said the findings show that most providers are "enthusiastically" embracing HIE adoption.

"Overall there is still that fine tuning and work that needs to be done until physician practices and hospitals alike are happy," FitzGerald said (Miliard, Healthcare IT News, 6/6).

Read more: http://www.ihealthbeat.org/articles/2013/6/7/physician-practices-increasingly-accepting-hies-retooling-ehrs.aspx#ixzz2VYtb7dBD

Health IT VC funding sees 'torrid' Q1 -- $493M raised so far

Mike Miliard, Managing Editor at healthcareitnews.com

With nearly half a billion dollars raised in venture capital funding for health information technology, the first three months of 2013 represented a "record quarter," according to Mercom Capital Group.

Some $493 million was raised industry-wide, according to Mercom's 2013 Healthcare IT Funding and M&A Report, in twice as many deals as the previous quarter (104, up from 51). There were nearly four times as many early stage deals – 42, up from 14 – compared to the fourth quarter of 2012.

The top deal for Q1 was a $41 million round of funding raised by Salt Lake City-based Health Catalyst, which developsdata warehousing technology. That was followed by $40 million raised by Geisinger Health System spinoff xG Health Solutions, whose data analytics platform is aimed at patient and population-focused care management.

Los Angeles-based NantHealth, which is working on advanced secure fiber networks, cloud computing and wireless technology for care delivery, raised $31 million. Fitbit, a fitness and health tracker company, and One Medical Group, a provider of online primary care services, both based in San Francisco, raised $30 million each.

"The trend we began to see last year of VCs investing in consumer-focused companies like mobile health, telehealth, personal health [and] social health ... has become much more pronounced," said Raj Prabhu, CEO of Mercom Capital Group, in a press statement. "The enormous market opportunity in consumer-focused health has appeared to pique the interest of investors and is likely to continue to grow as witnessed by the surge in VC activity."

More than 100 investors participated in deals in the first quarter of 2013, with ten investors involved in multiple funding rounds. Those with multiple rounds include Blueprint Health, Google Ventures, Maverick Capital, Merck Global Health Innovation Fund, Nike+ Accelerator, Norwest Venture Partners, Oak Investment Partners, Psilos Group, The Social+Capital Partnership and Y Combinator.

On the merger and acquisition front, there were 46 transactions this quarter, according to Mercom. Health information management companies were acquired most, with 22 transactions, followed closely by service providers with 11 acquisitions.

The largest disclosed transaction was athenahealth’s acquisition of Epocrates, which develops mobile medical apps for the point of care, for $293 million. Allscripts’ acquisition of health information exchange and interoperability firmdbMotion, for $235 million, was a close second, followed by JLL Partners’ $123 million acquisition of BioClinica, which develops technology for clinical trial management.

Feds Want to Extend Stark Law Exception

The Obama administration has proposed two rules to extend protections that allow hospitals to donate electronic health record technology to physicians who refer patients to their facility, The Hill's "RegWatch" reports (Goad, "RegWatch," The Hill, 4/8).

Background

The Stark Law bans payments that are aimed at encouraging referrals to hospitals. In addition, the federal anti-kickback law prohibits payments that are designed to influence care for Medicare beneficiaries.

However, in an effort to encourage physicians to adopt costly EHR systems:

• CMS established an exception to the Stark Law allowing hospitals to donate EHR software to physicians; and
• HHS' Office of Inspector General established a "safe harbor" provision to protect such EHR donations from anti-kickback enforcement, provided that the physicians cover 15% of the cost of the EHR technology.

The exceptions to the Stark and anti-kickback laws are scheduled to expire at the end of 2013 (iHealthBeat, 3/29).

Details of Proposed Rules

The Obama administration's proposal includes:

• A proposed rule from CMS that would extend the Stark Law exception for EHR donations to the end of 2016; and
• A proposed rule from OIG that would extend the safe harbor protections for EHR donations to the end of 2016 (Durben Hirsch, FierceEMR, 4/9).

 

In addition to extending the EHR donation protections, the new proposed rules would remove an electronic prescribing requirement from the original rules and adjust language regarding the types of EHR systems that qualify for exceptions (Conn, Modern Healthcare, 4/9).

OIG in its proposed rule said, "We expect these proposed changes to continue to facilitate the adoption of electronic health recor[d] technology" ("RegWatch," The Hill, 4/8).

CMS in its proposed rule said that it is considering extending protections for EHR donations to Dec. 31, 2021, to align with the end of the Medicaid portion of the meaningful use program.

Under the 2009 federal economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments.

Publication, Public Comments

The two proposed rules are scheduled to be published in the Federal Register on Wednesday.

Federal officials will accept public comment on the proposed rules for 60 days after their publication (Murphy, EHR Intelligence, 4/9).

Read more: http://www.ihealthbeat.org/articles/2013/4/9/federal-officials-seek-to-extend-protections-for-ehr-donations.aspx#ixzz2PzgTjelu

HFMA Project Points to the Power of BI

Kelsey Brimmer, Associate Editor, Healthcare Finance News

New initiative aims to help hospitals adapt to value-based model

 

Driven by skyrocketing healthcare spending, the Healthcare Financial Management Association has launched Value Journey, a new initiative with 35 hospital systems across the country to identify common challenges, as well as common capabilities, strategies and tactics. For at least one hospital – so far – business intelligence has become a focal point.

During the recent Maine Chapter HFMA Accounting Update conference in Freeport, Maine, Wayne Bennett, CFO at Franklin Community Health Network, FCHN,  in Farmington, Maine, explained how his organization -- one of the hospitals participating in the project -- has been focusing on one facet of the project, the use of business intelligence, to improve clinical and financial performance.

[See also: Rocky road ahead for BI.]

Bennett explained that within the Value Project, HFMA has suggested four common capabilities for hospitals to cultivate in order to adapt to a value-based business model, which includes: people and culture; performance improvement; contract and risk management; and business intelligence.

FCHN began its journey by focusing on a combination of two issues: data warehousing and data integration technologies; and desktop query, reporting and analysis tools for self-service access to information, said Bennett.

“Putting the two together -- data warehousing and desktop query -- allows us to really understand this,” said Bennett.  “Relationships of data drive the business intelligence, and you can stop working off of anecdotal information and focus on straight facts. Really, data intelligence is an evolution.”

[See also: 6 ways to use business intelligence software.]

The evolution of business intelligence maturity, explained Bennett, begins with production reporting, moves to spreadmarks, and then eventually moves towards data marts and data warehouses, where data is pooled and reports are run off of a common database, rather than separated databases from each department of the hospital.

“We are at the data warehousing period of the evolution, where we are not only working off of one database, but we are also delivering business intelligence dashboards of information and putting more energy on analyzing information, rather than gathering information,” said Bennett.

He explained that FCHN partnered with PowerHealth Solutions, which specializes in hospital data systems for patient costing and billing, to work on getting their hospital data out of specific systems in the organization and into one data warehouse.

The evolution does not stop at data warehousing though, explained Bennett. From data warehousing, organizations can then make the leap to enterprise data warehousing, where “people begin studying the data and working on improving costs and solving problems,” he said.

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Most Incentive Money Spent on More IT

by Paul Cerrato, Contributing Writer for Healthcare IT News

With no federal rules telling providers how they can spend their meaningful use incentive checks, hospitals and practices have their options wide open. While many are investing in more technology, that’s only the tip of the proverbial iceberg.

Acacia Internal Medicine Specialists in Phoenix, for example, has used part of its check to invest in a community room to hold wellness classes, and to hire a tai chi teacher. However, the prevailing trend is to use the money to fund more IT growth and pay down debt incurred while putting in the software and hardware needed to qualify for MU in the first place.

[See also: 2012: The year meaningful use took hold.]

“Most of our clients are considering the incentive funds paid as an offset for funds they are spending in advance to qualify for meaningful use and to pay for anything additional they will require to meet Stages 2 and 3,” wrote a member of a hospital technology group on LinkedIn in a discussion about how hospitals will use their MU dollars.

“The clear pattern we’re seeing among the hospitals we work with is that they are using their incentive payments to fund current and future IT initiatives.”, said Jim Adams, executive director, research and insights at The Advisory Board Company. Most have earmarked the money for EMR enhancement or optimization, he added, and some hospitals are also investing in their own health information exchanges, or rolling out an ambulatory EMR for physicians’ offices affiliated with the hospital.

The Advisory Board Company estimates that to date each Medicare eligible professional received on average about $17,300, while Medicaid eligible professionals received about $21,600. A hospital with about 34,000 discharges per year, two-thirds of whose revenue came from Medicare, can expect to receive about $13 million over the next few years, according to Adams.

[See also: EHR incentive payments top $12 billion.]

Many healthcare organizations are unable -- or unwilling -- to go on record about how they are spending the money. Some providers may be unwilling to disclose this information because they consider it proprietary, but it’s also possible they have miscalculated the anticipated ROI.

A recent analysis reported in Health Affairs came to the conclusion that EHRs are a money losing proposition for most physicians. Julia Adler-Milstein, from the University of Michigan in Ann Arbor, and her associates, surveyed 49 community practices and projected that the average doctor “would lose $43,743 over five years; just 27 percent of practices would have achieved a positive return on investment; and only an additional 14 percent of practices would have come out ahead had they received the $44,000 federal meaningful use incentive.”

2012: US remote patient monitoring $10.6B market

by Jonah Comstock

Kalorama Information released a report this year on remote patient monitoring, stating that the US market increased from $8.9 billion in 2011 to $10.6 billion in 2012, an increase of 19 percent. Kalorama’s numbers looked at what the New York-based research firm calls “advanced remote patient monitoring”, which it defines as technologies that have wireless or remote capabilities and can potentially interact directly with an EHR.

“Patient monitoring systems with advanced features, especially wireless or remote capability, are among the fastest-growing medical devices,” the report’s abstract reads. “The aging population and the associated increases in diseases such as congestive heart disease and diabetes as well as the cost of treating those conditions, is driving sales of these devices. Use of new patient monitoring technologies can result in a need for fewer personnel, increased coverage by existing personnel, and a reduction in errors and are expected to lead to better patient care and the recognition of serious health problems before they become an issue.”

That 19 percent growth tracks with a prediction Kalorama made last July, when it asserted the market would grow by 18 percent annually. That rate would put the US market at $20.9 billion by 2016, the previous report said. That same report indicated there had been a 23 percent annual growth rate between 2007 (when the market was worth $3.9 billion) and 2011’s $8.9 billion.

At the start of 2011, Kalorama predicted that remote monitoring technology would hit $6 billion that year — a prediction that appears to have been surpassed. Back then, the firm was more ambitiously predicting a 26 percent annual growth rate.

If these numbers seem high compared to, for instance, GBI’s March 2012 report, which predicted an $8 billion market in 2017, it could be because Kalorama has an unusually wide definition for remote monitoring: the firm includes some in-hospital patient monitoring in its numbers, not merely telehealth.

“This year we tried something different: we segmented the market between two types of information that customers request from us,” Publisher Bruce Carlson wrote on Kalorama’s blog. ”We have a segment on hospital patient monitoring, which is still remote ([patient monitoring] between the rooms or floors or even buildings of a hospital) and telemedicine, where the patient monitoring occurs between patient and provider.”

In addition to US data, Kalorama tracks the global markets in its paid reports. In the same blog post, the firm revealed that worldwide market growth from 2011 to 2012 for advanced patient monitoring was 17 percent.

EHR Incentive Payments Top $12 Billion

Mary Mosquera, Sr. Editor at healthcareitnews.com

With some healthcare providers now into their second year of meaningful use reporting, Medicare and Medicaidelectronic health record payments were estimated at $12.3 billion paid to a total of 219,000 physicians and hospitals through February since the program’s inception.

The Centers for Medicare & Medicaid Services will post final figures for February later this month as it captures more complete data, said Robert Anthony, a specialist in CMS’ Office of eHealth Standards and Services at Thursday’s Health IT Policy Committee meeting, which was broadcast live.

 

In February, 27,500 Medicare physicians received $425 million; 5,500 Medicaid clinicians and eligible professionals, $100 million; and 90 hospitals in either program, $200 million, for a total of $725 million to 33,090 providers.

 

[See also: EHR incentives over $10B to date.]

 

“February was a big month, as we expected. A lot of Medicare eligible professionals came in and attested in the final month to be counted in the 2012 program,” Anthony said.

 

“We expect that February number will continue to grow as we process them through the month. We’re already seeing some providers come in for 2013,” he added.

 

The incentive program has been operating long enough now that some providers are second-time participants, so CMSlists only unique providers paid.

 

Since the program’s inception through February, CMS has paid 140,000 Medicare physicians, 75,500 Medicaid clinicians and 3,757 hospitals, according to latest estimates.

 

The number of eligible providers registered for the EHR incentive program was just shy of 85 percent of hospitals, and 73.2 percent of hospitals have been paid as of January.

 

“For eligible professions, two-thirds are registered and almost 40 percent have been paid under Medicare, Medicaid or Medicare Advantage,” Anthony said.

 

CMS also found that the performance level was comparable between providers attesting for the first time in 2011 or 2012 on their core and menu objective measures.

 

“We’re seeing consistently high performance. If anything, we see a slight increase as we move to a full year, but most is not statistically significant,” Anthony said.

 

However, there were indications that as providers move into a second year of meaningful use, “the workflow becomes more routine, and they are performing at a slightly higher level than when they began,” he said.

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Survey: Healthcare Careers Sizzling

Bernie Monegain, Editor for Healthcare IT News

Healthcare continues to be one of the hottest areas for hiring across the country – and an area where it's crucial to recruit the right talent – according to a survey by recruiting firm CareerBuilder.

CareerBuilder’s annual survey finds 22 percent of healthcare hiring managers plan to add full-time, permanent healthcare employees in this year, up three percentage points over 2012. At the same time, 23 percent of healthcare employers reported they have open positions for which they can’t find qualified talent.

Thirteen percent of all U.S. jobs are in healthcare and the Bureau of Labor Statistics estimates that the U.S. will add 5.6 million health care jobs from 2010 to 2020, the largest projected increase of any industry.

CareerBuilder announced today a new division specifically for healthcare with stronger market intelligence, more customized recruitment and information on healthcare trends and workforce issues.

[See also: Healthcare IT hiring: A new frontier.]

"The recession had very little impact on the hiring momentum of the healthcare industry and, to meet further demand, CareerBuilder has pooled a group of proficient experts into a new division that will focus solely on assisting healthcare client’s hiring needs efficiently and effectively," said Jason Lovelace, president of the Health Care Group at CareerBuilder, in a news release. "Our research suggests that heathcare hiring will accelerate in 2013 with heightened competition for high skill labor and improved compensation trends. As a result, it is essential that we arm our healthcare clients with the data and tools needed to recruit qualified talent and ultimately, positively impact patient care."

Temporary and contract hiring

More healthcare organizations are turning to staffing and recruiting companies and temporary workers to help meet increased market demands, according to Lovelace Thirty-six percent of healthcare employers plan to hire temporary and contract workers in 2013, up from 34 percent last year, the Career Builder survey shows. Among these employers, 37 percent plan to transition some temporary workers into full-time, permanent employees over the next 12 months. There are an increasing number of areas – information technology is one – where demand for skilled positions – is growing much faster than the supply.

Harris Interactive conducted the online survey on behalf of CareerBuilder, among 274 health care hiring managers and human resource professionals and 576 healthcare workers (employed full-time, not self-employed, non-government) between Nov.1-Nov. 30, 2012