THE OFFICIAL MAGAZINE OF THE MICHIGAN STATE MEDICAL SOCIETY » VOL. 117 / NO. 4
September / October 2018
EHRs and Interoperability: The Fatal Flaw
“Interoperability” is a buzz word for politicians, but for physicians it’s the tech era’s white whale.
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FEATURES & CONTENTS September / October 2018
08
Wrapping Up the 2017-18 Flu Season and Looking Ahead to Prevent Flu in 2018-19 BY STEFANIE COLE, BSN, RN, MPH
12
Michigan Primary Elections Bring Surprises; Expected Outcomes BY CHRISTIN T. NOHNER, DIRECTOR, STATE AND FEDERAL GOVERNMENT RELATIONS, MICHIGAN STATE MEDICAL SOCIETY
22
EHRs Can Advance Good Medicine If Doctors Are Aware of the Risks BY DAVID B. TROXEL, MD Contributed by The Doctors Company
COLUMNS 04 President's Perspective
BY BETTY S. CHU, MD, MBA
06 Ask Our Lawyer
18
BY DANIEL J. SCHULTE, JD
10 Ask Human Resources
BY JODI SCHAFER, SPHR, SHRM-SCP
14 Health Care Delivery
BY LUANN JENKINS, CPMA, CMRS, CPC, CEMC, CFPC, MEDTRUST, LLC
FEATURE
EHRs And Interoperability: The Fatal Flaw BY NICK DELEEUW FOR THE MICHIGAN STATE MEDICAL SOCIETY
“Interoperability” is a buzz word for politicians, but for physicians it’s the tech era’s white whale. Read more about on page 18.
STAY CONNECTED!
SEPTEMBER / OCTOBER 2018 |
michigan MEDICINE 3
perspective
MICHIGAN MEDICINE® VOL. 117 / NO. 5 Chief Executive Officer JULIE L. NOVAK Managing Editor KEVIN MCFATRIDGE KMcFatridge@msms.org Marketing & Sales Manager TRISHA KEAST TKeast@msms.org Publication Design STACIA LOVE, REZÜBERANT! INC. rezuberant.com Printing FORESIGHT GROUP staceyt@foresightgroup.net
Interoperability.
Publication Office Michigan Medicine 120 West Saginaw Street East Lansing, MI 48823 517-337-1351
The “white whale”
www.msms.org All communications on articles, news, exchanges and advertising should be sent to above address, ATT: Trisha Keast. Postmaster: Address Changes Michigan Medicine Hannah Dingwell 120 West Saginaw Street East Lansing, MI 48823
Michigan Medicine®, the official magazine of the Michigan State Medical Society (MSMS), is dedicated to providing useful information to Michigan physicians about actions of the Michigan State Medical Society and contemporary issues, with special emphasis on socio-economics, legislation and news about medicine in Michigan. The MSMS Committee on Publications is the editorial board of Michigan Medicine and advises the editors in the conduct and policy of the magazine, subject to the policies of the MSMS Board of Directors. Neither the editor nor the state medical society will accept responsibility for statements made or opinions expressed by any contributor in any article or feature published in the pages of the journal. The views expressed are those of the writer and not necessarily official positions of the society. Michigan Medicine reserves the right to accept or reject advertising copy. Products and services advertised in Michigan Medicine are neither endorsed nor warranteed by MSMS, with the exception of a few. Michigan Medicine (ISSN 0026-2293) is the official magazine of the Michigan State Medical Society, published under the direction of the Publications Committee. In 2018 it is published in January/February, March/April, May/ June, July/August, September/October and November/December. Periodical postage paid at East Lansing, Michigan and at additional mailing offices. Yearly subscription rate, $110. Single copies, $10. Printed in USA. ©2018 Michigan State Medical Society
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of electronic health and medical records. A quixotic quest. The Holy Grail.
By Betty S. Chu, MD, MBA, Michigan State Medical Society President
®
W
hen President Obama in 2009 signed into law the American Recovery and Reinvestment Act, physicians across the nation were asked to make meaningful use of EHR and EMR, for the benefit of their patients and their practices.
Of course, here in Michigan, physicians had been hard at work pursuing more efficient, more effective, and more accessible care for their patients years before Congress started paying attention. No wonder the state of Michigan outpaces the national average when it comes to the rates of physicians meeting federal guidelines for meaningful use of certified health information technology programs. You’ve been working hard, but health information and technology vendors have too often struggled to keep up with you. The lack of interoperability between various EHR systems, and the impact those systems are having on the bottom line through things like downcoding and increased auditing by payers is a very real frustration for physicians from one corner of the state to the next.
BETTY S. CHU, MD, MBA MSMS PRESIDENT
In this edition of Michigan Medicine, you’ll learn more about the national journey towards effective electronic health records, what it means for your patients, and where vendors and bureaucrats have fallen flat. You’ll also learn about what groups like the Michigan State Medical Society and others are doing to make meaningful use more possible, to break down technological silos, and to improve patients’ access to their own records. We’ve even included some simple but important tips your practice may want to consider to minimize the likelihood of payer audits and payment headaches. Washington, D.C. won’t solve these problems. Thankfully, you and your colleagues are already on the case.
Betty Chu, MD, MBA MSMS President
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ASK OUR LAWYER
Increased Patient Email Traffic By Daniel J. Schulte, JD, Michigan State Medical Society Legal Counsel
Q: Patients are increasingly insisting on email communication with me regarding diagnosis and treatment. I am seeing more and more of my colleagues advertising their email addresses and encouraging patients to communicate with them by email. What are the legal issues involved with sending/receiving diagnosis, treatment and other medical record information by email?
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T
here has been a significant trend to increase physician-patient communication by the use of email. This trend will likely continue with the further development of the interoperability of electronic health records, e-prescribing methodologies and other uses of health information technologies to control healthcare costs, increase efficiency, promote pay for performance and generally to expand access to medical care. The use of email to communicate with patients is not without regulation or risk. HIPAA’s Security Rule must be complied with and you should consider the effect email messages might have on your ability to defend yourself in a malpractice case. HIPAA’s Security Rule sets forth administrative, technical and physical security procedures to required to be implemented by covered entities (e.g. physicians) to ensure the confidentiality of electronic protected health information. This information includes most medical record information maintained, transmitted, etc. in an electronic form, like emails. Physician practice’s must meet the Security Rule’s Standards by adopting its Implementation Specifications (guidelines for how each Standard may be met). Which Standards will apply to your practice and the Implementation Specifications you should employ to meet those Standards will vary depending on the size, available resources, etc., of each physician practice. One such Standard applicable to patient emails is the Transmission Security Standard. This Standard requires the use of measures to prevent unauthorized access to electronic protected health information when that information is communicated electronically. The hallmark of the Implementation Specifications for the Transmission Security Standard is encryption. The specification requires use of software or a third party service to encrypt patient emails (i.e. converting them into unread-
able text that is later converted back into comprehensible text when received by the patient). You should never use or respond to patient emails via unencrypted commercial email services. In addition to insuring the security of information in an email during transmission, you must consider the use of this type of communication in medical malpractice litigation. Your emails to patients can and will be used as evidence. Whether you messages will help or hurt your defense will depend on the content of the email, the propriety of its use in a given situation, etc. Physicians communicating with patients regarding their diagnosis and treatment by email should ensure that their messages contain clearly written, complete and appropriate information. Using the same acronyms, abbreviations, shorthand descriptive terms, etc., that you would in documenting something in a patient’s medical record will likely not be viewed as appropriate in an email to a patient. Any misunderstanding or misinterpretation by the patient that results will certainly be used against you in malpractice litigation. All of your email communication with a patient should be retained in the patient’s medical record. The inclusion of these communications in the medical record is necessary to ensure your complete knowledge for subsequent treatment decisions and the treatment decisions of other physicians providing treatment to the patient. Finally, it is a best practice to include an auto-reply message on your system so that patients are aware you may not respond to their message immediately and letting them know that if they are experiencing what they believe to be an emergency situation to go to an emergency room without delay. DANIEL J. SCHULTE, JD, MSMS LEGAL COUNSEL IS A MEMBER AND MANAGING PARTNER OF KERR RUSSELL
Join us for the 61st Annual Allen Silbergleit, MD Clinic Day • November 14, 2018 Antibiotic Stewardship in the 21st Century St. Joseph Mercy Oakland Anthony M. Franco Communications Center Continental Breakfast & Program: 7:15 a.m. - 12:30 p.m. Luncheon will immediately follow the program. Contact Wilbur Smith, MD at Wilbur.Smith@stjoeshealth.org or call 248-858-6796 for more information.
SEPTEMBER / OCTOBER 2018 |
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MDHHS UPDATE
Wrapping Up the 2017-18 Flu Season and Looking Ahead to Prevent Flu in 2018-19 By Stefanie Cole, BSN, RN, MPH, Immunization Nurse Educator, Michigan Department of Health and Human Services Division of Immunization
The 2017-18 influenza season (defined as October 1, 2017–May 19, 2018) was a high severity season for all age groups in the United States.
L
evels of flu activity are measured using multiple surveillance systems including laboratory data, outpatient visits due to influenza-like illness (ILI), hospitalizations, and deaths. The U.S. experienced high levels of outpatient clinic and emergency department visits due to ILI, high flu-related hospitalization rates, and widespread flu activity across the country for an extended period in 2017-18. Nationally, ILI began to increase in November 2017, peaked at the end of January/beginning of February 2018, and did not return to baseline levels until early April. Overall, 2017-18 was an influenza A(H3N2)-predominant season, although influenza B viruses predominated from March onward.1 Unfortunately, the 2017-18 flu season saw a record number of influenza-associated pediatric deaths. As of June 1, 2018, 171 flu-associated pediatric deaths were confirmed nationally. The ages of these children ranged from 8 weeks to 17 years with an average age of 7 years. For those children whose medical history was known (n=154), 51% had at least one underlying medical condition that put them at higher risk for flu complications. The other half were previously healthy kids. Among the 138 children who were at least 6 months of age and for whom vaccination status was reported, only 22% received at least one dose of 2017-18 flu vaccine before becoming ill.1 Further, as of July 14, 2018, the number of flu-associated pediatric deaths nationally increased to 178, two of which were Michigan children.2,3 Since influenza pediatric deaths became a reportable condition in 2004, the only other flu season with more pediatric flu deaths than this past season was the 2009 pandemic.1 The 2017-18 season underscored the importance of ensuring children are vaccinated against influ-
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enza, regardless of if they have underlying medical conditions. Some children will need two doses of flu vaccine during the upcoming flu season. To find out which children need two doses, visit www.michigan.gov/flu and click on the “Current Flu Season Vaccination Materials for Health Care Professionals” to find this and other flu vaccine educational resources.
ate, licensed flu vaccine may be used. After two years off the market, live, attenuated influenza vaccine (LAIV4, FluMist®) was recommended by ACIP in February 2018 as an option for flu vaccination of persons for whom it is appropriate for the 2018–19 season.6 The complete 2018-19 flu vaccine recommendations can be found at www. cdc.gov/mmwr.
Estimates from November 2017 found that only about two in every five children and adults in the U.S. had received flu vaccine. About 65% of children who had received flu vaccine by November got it at a doctor’s office. For adults, about 35% got flu vaccine at a doctor’s office and 28% were vaccinated in a pharmacy or store. Because infants younger than 6 months are too young to be vaccinated against flu, vaccinating pregnant women is an important strategy to protect them. Unfortunately, as of November 2017, flu vaccination coverage among pregnant women before and during pregnancy was only 35.6%. All end-season flu vaccine coverage estimates for 2017-18, including Michigan-specific estimates, will be published in September 2018.4
Make sure you begin vaccinating all persons aged 6 months and older as soon as your office receives flu vaccine. Vaccinate not only to protect your patients but also anyone they may encounter, including infants who may be too young to receive flu vaccine themselves.
The Northern Hemisphere’s 2018-19 flu vaccine composition includes an A/Michigan/45/2015 A(H1N1)pdm09-like virus, an A/Singapore/INFIMH-16–0019/2016 A(H3N2)-like virus, and a B/Colorado/06/2017-like (B/Victoria lineage) virus. Quadrivalent vaccines include these three strains plus a B/Phuket/3073/2013-like (B/ Yamagata lineage) virus.1 In June 2018, the Advisory Committee on Immunization Practices (ACIP) voted to continue the universal flu vaccine recommendation for all persons aged 6 months and older for the 2018-19 season.5 ACIP does not recommend any flu vaccine over another, but recommends that any age-appropri-
REFERENCES 1 Garten R, Blanton L, Elal AI, et al. Update: Influenza Activity in the United States During the 2017–18 Season and Composition of the 2018–19 Influenza Vaccine. MMWR Morb Mortal Wkly Rep 2018;67:634–642. DOI: http://dx.doi.org/10.15585/mmwr.mm6722a4 2 Centers for Disease Control and Prevention. Weekly U.S. Influenza Surveillance Report: https://www.cdc. gov/flu/weekly/ 3 Michigan Department of Health and Human Services. Past Michigan Flu Focus Surveillance Reports: https://www.michigan.gov/mdhs/0,5885,7-33971550_2955_22779_40563-143382--,00.html 4 Centers for Disease Control and Prevention. FluVaxView, 2017-18 Flu Season: https://www.cdc.gov/flu/ fluvaxview/1718season.htm 5 Centers for Disease Control and Prevention. Advisory Committee on Immunization Practices (ACIP): https:// www.cdc.gov/vaccines/acip/meetings/meetings-info. html 6 Grohskopf LA, Sokolow LZ, Fry AM, Walter EB, Jernigan DB. Update: ACIP Recommendations for the Use of Quadrivalent Live Attenuated Influenza Vaccine (LAIV4) — United States, 2018–19 Influenza Season. MMWR Morb Mortal Wkly Rep 2018;67:643–645. DOI: http://dx.doi.org/10.15585/mmwr.mm6722a5
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ASK HUMAN RESOURCES
Confrontation is hard, but saying hard things doesn't have to be paralyzing By Jodi Schafer, SPHR, SHRM-SCP
Q: I became a doctor because I like helping people. I enjoy almost every part of my job except managing staff. Don’t get me wrong, I like the teambuilding components, but I hate confrontation. It seems that my staff knows this by the number of policy violations I let them get away with. I try to address it, but it seems like by the end of the meeting I am apologizing to them! I begin the conversation with the best of intentions and then if it gets really uncomfortable, I find myself agreeing with their point of view in order to end the meeting without hurting any feelings. This has to change; I am losing control of my staff. What do I say and how do I say it?
You are not alone. Not many people enjoy confrontation. We all want people to like us, so we are nice and hope for the best. However, leadership is not about nice, it’s about being kind. Kindness sometimes means that you have to say things that people may not want to hear, but that they NEED to hear if they are to improve and be successful. ‘Nice’ is for you – it makes you feel good. ‘Kind’ is for others – it requires that you sacrifice for their benefit. In this case, the sacrifice you are making is your comfort level. When you talk to your employees about uncomfortable topics, you want to keep the focus on what the person did (or didn’t) do – the behavior/performance; rather than why you think this is happening – the motive. I’m going to provide you with a basic framework to help you prepare for and lead conversations like this, but first things first – do a gut check. Make sure you have a good reason for having this conversation in the first place. What do you hope to achieve and are you willing to go through the effort and potential awkwardness of confrontation to get it? Your resolve has to be strong because you know your employees will test you. Once you are mentally ready to move forward, follow these key steps:
Prepare your Message Know the key points you want to address and any details you want to have on-hand that substantiate your concerns. Your demeanor will set the tone for the whole meeting, so you need to be in a calm, rational state of mind before you begin.
Deliver your Message – Respectfully and Professionally Begin the meeting by telling the employee why you’ve asked them to meet with you; the FACTS as you know them surrounding the issue at hand. Eliminate the small talk – it only confuses things. Share your thoughts/feelings about why this issue is a problem. This is where you can refer to violations of written policies, the impact on others, the impact on you, etc.
Invite a Response Transition from you to them by saying something like, ”Help me understand what’s going on?”, “What might be causing this?”, “Were you aware of this?”, etc. Let your employee have the floor. Stop talking and start listening.
Respond when necessary, but do not defend and do not interrupt This is not an argument nor is it a negotiation. Focus on keeping the conversation respectful and professional, even if you disagree. If the employee becomes upset or angry, you can offer them a few minutes to collect their thoughts before you start again, but do not allow behavior to spiral out of control.
Restate your expectations Once the conversation reaches its natural conclusion, state/restate your expectations for this employee going forward and potential consequences if improvement is not made.
Thank person for their time/thoughts/efforts and end the meeting. You must be serious about the conversation and your expectations for the future if you want the employee to be serious. Once the meeting ends, the real work begins because the real power is in the follow through!
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Symposium for Primary Care Medicine Friday and Saturday, November 2-3, 2018 The Diamond Banquet Center connected to the Hyatt Place Hotel at the Suburban Collection Showplace, Novi, Michigan For Physicians, Physician Assistants and Nurses: 16.0 Category 1-A AOA CME Credits 16.0 AMA PRA Category 1 Credit(s) ™ Specialty Credits Issued 16.0 Internal Medicine | 16.0 Family Medicine Featuring a Self-Guided ECG Virtual Workshop Sponsored by:
AT THE
Register at: beaumont.cloud-cme.com/fallprimarycare2018 Direct questions to: cme@beaumont.edu or call 248-551-0200
SEPTEMBER / OCTOBER 2018 |
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ADVOCACY
Michigan Primary Elections Bring Surprises; Expected Outcomes By Christin T. Nohner, Director, State and Federal Government Relations, Michigan State Medical Society
N
ationwide eyes were fixed on the August
Governor
7th primaries and special elections in
In the race to become the state’s next Governor, former Senate Minority Leader and Ingham County Prosecutor Gretchen Whitmer and Attorney General, Bill Schuette, handily beat their opponents to claim their respective party nominations with the highest voter turnout for a primary in Michigan history.
Michigan, Ohio, Missouri, Kansas, and
Washington state. There was no shortage of speculation about how the outcome may reflect the temperature of the electorate in November. The primary in Michigan was peppered with surprises as well as expected outcomes. Below are some of the highlights MSMS members may want to note. Of particular note, there is a rise in Michigan physicians running for office:
Michigan doctors are taking their medical experience to the campaign trail via MLive.
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Whitmer defeated her opponents Abdul El-Sayed, MD, and Shri Thanedar in all 83 counties . Much to the surprise of many, Whitmer outmatched El-Sayed in areas of Detroit, which many thought were heavily favorable towards him. Schuette rode an endorsement from President Donald Trump to an easy victory over Lieutenant Governor Brian Calley and Senator Patrick Colbeck in all but three counties (Barry, Clinton and Ionia). Jim Hines, MD, an obstetrician from Saginaw, came in fourth with 11 percent of the vote.
U.S. Senate Republican John James, a 37-year-old Operation Iraqi Freedom veteran, will face incumbent Senator Debbie Stabenow in November. James received the endorsement of President Donald Trump, defeating his opponent Sandy Pensler 56.8 percent to 42.6 percent. Senator Stabenow has held the seat since 2000 after upsetting incumbent Republican Senator Spencer Abraham.
U.S. House With competitive primaries on both sides of the ballot, Republican Lena Epstein and Democrat Haley Stevens both emerged victorious and will face off in the November race for the 11th Congressional District, a seat being vacated by Republican Congressman David Trott. Matt Longjohn, MD, a physician and former National Health Officer for the YMCA won the Democratic primary in the 6th Congressional District but faces an uphill battle against incumbent Congressman Fred Upton. Rob Davidson, MD, an emergency medicine physician running in the 2nd Congressional District Democratic primary will also face a tough raceagainst incumbent Congressman Bill Huizenga. Former Representative Rashida Tlaib defeated Detroit City Council President Brenda Jones for the full two-year term to replace Congressman John Conyers in the 13th Congressional District, who resigned from office late last year amid allegations of sexual misconduct. Interestingly, Jones won the race for the shortterm vacancy (through the end of 2018) but as this magazine went to print, it was unknown whether she would choose to assume the position for such a short period of time. Elissa Slotkin easily defeated candidate Chris Smith in the 8th Congressional District Democratic primary and will face incumbent Congressman Mike Bishop in November.
Michigan State Senate Representative John Bizon, MD, decisively beat his opponent, chiropractor and Former Representative Mike Callton, for the 19th district Senate seat. Representative Bizon is all but assured victory in November in the Republican-favored district. In an unexpected development, Senator David Knezek lost his 5th District Senate seat to little-known Betty Jean Alexander who filed a waiver and spent less than $1,000 on her campaign.
Representative Roger Victory beat Representative Daniela Garcia and Former Representative Joseph Haveman in a competitive and expensive 30th Senate District primary. He is poised for a smooth path to victory in the general. Senate Health Policy Chair Mike Shirkey decisively beat his opponent Matt Dame in the Republican primary in the 16th District. Shirkey is likely to sail through the general election and is positioned to be the next Senate Majority Leader. In the Upper Peninsula’s 38th State Senate District, former Representative Ed McBroom will face Representative Scott Dianda for the seat held by term-limited Senator Tom Casperson. While the district tends to vote Republican, Dianda enjoys popularity in the region.
Michigan State House Incumbent Representative David Maturen was defeated by longtime Republican grassroots activist Matt Hall in the 63rd House District. Meridian Township Treasurer Julie Brixie defeated former Ingham County Commissioner Penelope Tsenoglou 47 to 37 percent in the 69th House District seat currently held by termlimited Representative Sam Singh. House Health Policy Chair Henry ‘Hank’ Vaupel, a veterinarian, will face Democrat Colleen Turk, an IT professional with Sparrow Health System in Lansing. Representative Vaupel the 47th District Senate seat.
Rise Up with MDPAC With some seats all but cemented following the primaries and others still to watch in November, it’s important
Former Representative Jon Bumstead of Newaygo is poised to succeed Senator Goeff Hansen, who is termed out, after defeating current Representative Holly Hughes in the 34th Senate District Republican primary. In November, he will face Democrat Poppy Sias-Hernandez in a 50-50 district that has historically favored Republicans.
to keep in mind the critical role of MDPAC, Michigan’s
In the 12th Senate District Republican Primary Representative Michael McCready beat establishment candidate Representative Jim Tedder by a narrow margin of 45.4 percent to 44.3 percent. Barring a democratic wave in November, McCready is likely to win the general election.
and educate new lawmakers. MDPAC only supports
Former Representative Kevin Daley of Lum decisively beat Representative Gary Glenn in the 31st Senate District and faces off against Bay County Clerk Cynthia Luczak in the general election in the competitive but Republican-leaning district.
but our success is only possible with your support.
largest political action committee dedicated exclusively to advocacy for physicians. January will bring many fresh faces to Lansing and physicians need a strong voice to elevate our profile candidates and legislators who care about the issues zzzzzx0that matter most to Michigan physicians. We are gearing up for the battles that lay ahead in 2019
Visit MDPAC.org and donate today!
Representative Tom Barrett will face public relations professional Kelly Rossman-McKinney in November for the 24th District. Former Representative Aric Nesbitt of Lawton won the Republican nomination for the 26th District Senate seat and will assuredly walk into the seat in November. SEPTEMBER / OCTOBER 2018 |
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HEALTH CARE DELIVERY
Medicare Payment and Promoting Interoperability By LuAnn Jenkins, CPMA, CMRS, CPC, CEMC, CFPC, MedTrust, LLC
The past several years has seen an evolution of the Medicare Electronic Health Record (EHR) Incentive Program (a.k.a. “Meaningful Use”) from a stand-alone incentive program to one of four performance categories under the Merit-Based Incentive Payment System (MIPS) which is one of the payment tracks under the Quality Payment Program (QPP).
P
ursuant to the authority granted under the Medicare Access and CHIP Reauthorization Act (MACRA), which provides the legislative authority for the QPP and MIPS, the Centers for Medicare and Medicaid Services has continued to refine and align “Meaningful Use” to meet broader health information sharing goals. Additionally, programmatic changes also provide users with greater flexibility in selecting reportable measures. As part of MIPS, key components of “Meaningful Use” were encompassed into the Advancing Care Information (ACI) performance category. The scores from this category along with quality, cost and care improvement comprise a participating eligible clinician’s (EC) total MIPS score which determines whether the EC receives an upward, neutral or downward payment adjustment. This year, ACI has been renamed the Promoting Interoperability (PI). The name
change is intended to better reflect CMS’ desire to promote patient engagement and the electronic exchange of health information using certified electronic health record technology (CEHRT).
2018 PI Requirements In 2018, the PI performance category is worth 25% of an EC’s MIPS final score. It should be noted; however, that this percentage can change due to special statuses, exception applications or Alternative Payment Model (APM) participation. Below is an overview of the PI performance category and how to participate provided by CMS at qpp.cms.gov.
What PI Data Should I Submit? There are two measure sets for data: 1. Promoting Interoperability Objectives and Measures 2. Promoting Interoperability Transition Objectives and Measures.
The measure set you choose is based on your CEHRT edition. If your CEHRT is certified to the 2014 Edition, you must use the Promoting Interoperability Transition Objectives and Measures set. Otherwise, you may use either set, or any combination of the two sets. When choosing the combination of technologies path, however, you may not submit a measure from the Promoting Interoperability Objectives and Measures set that correlates to a measure from the Promoting Interoperability Transition Objectives and Measures set. For example, if you submit the "Immunization Registry Reporting" measure from the Promoting Interoperability Transition Objectives and Measures set, you may not submit the correlating "Immunization Registry Reporting" measure from the Promoting Interoperability Objectives and Measures set.
For more details, review CMS’ 2018 MIPS Promoting Interoperability Performance Category Fact Sheet available at https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Promoting-Interoperability-Fact-Sheet.pdf 14 michigan MEDICINE
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Requirements For Performance Year 2018, Certified EHR Technology (CEHRT) is required for participation in this performance category. Participants must submit collected data for 4 or 5 Base Score measures (depending on the CEHRT Edition) for 90 days or more during 2018. In addition to submitting the Base Score measures, participants must attest to two statements when submitting: “Prevention of Information Blocking Attestation,” and “ONC Direct Review Attestation.” To improve results, participants may: Collect and submit data for up to 9 Performance Score measures (or 7 Performance Score measures if you choose the PI Transition Objectives and Measures set)
Promoting Interoperabiity Performance Category Score
+ Base + Performance + Bonus Score Score Score
EXAMPLE: If an MIPS eligible clinician receives the base score (50%) and a 40% performance score and no bonus score, they would earn a 90% PI performance category score. When weighted by 25%, this would add 22.5 points to the overall MIPS final score. (90 X .25 = 22.5).
Earn bonus percentage points by: Submitting “yes” for 1 or more additional public health agencies or clinical data registries beyond the one identified for the performance score measure Submitting 1 or more “CEHRTEligible” improvement activities and submit “yes” to the completion of at least 1 of the specified improvement activities Submitting only from the PI Objectives and Measures set (and only using 2015 edition CEHRT) For a list of the Interoperability measures, go to the qpp.gov website or https://qpp. cms.gov/mips/explore-measures/promoting-interoperability?py=2018#measures.
How Should I Submit Data? There are four ways participants can submit data: Attestation in the QPP data submission system Electronic Health Record (EHR) Qualified Clinical Data Registry (QCDR) 2018 CMS-Approved QCDRs (ZIP) Qualified Registry 2018 CMS-Approved Qualified Registries (ZIP)
Hardship Exceptions A clinician or group participating in MIPS may submit a Quality Payment Program hardship exception application, citing one of the following specified reasons for review and approval: MIPS eligible clinician in a small practice MIPS eligible clinician using decertified EHR technology Insufficient Internet connectivity Extreme and uncontrollable circumstances Lack of control over the availability of CEHRT For clinicians participating in MIPS, getting a hardship exception means that the Promoting Interoperability performance category receives 0 weight in calculating your final score and the 25% is reallocated to the quality performance category. Some clinicians who participate in MIPS are granted Special Status (for example hospital-based clinicians) will be automatically reweighted and will not need to submit a Quality Payment Program hardship exception application.
Lacking CEHRT does not qualify the MIPS-eligible clinician or group for reweighting. MIPS-eligible clinicians and groups that are participating in a MIPS Alternative Payment Model (APM) may be excepted from reporting information for the Promoting Interoperability performance category if they meet the criteria. If you are a MIPS-eligible clinician, you must submit an application by December 31, 2018 for CMS to reweight the Promoting Interoperability performance category to 0 percent. The application will be available from August 6, 2018 - December 31, 2018.
How Do I Apply? The Quality Payment Program Exception Application for PY 2018 is open from August 6, 2018 - December 31, 2018. You may also contact the Quality Payment Program Service Center and work with a representative to verbally submit an application. Applications are subject to annual renewal.
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Frequently Asked Questions Regarding PI Hardship Exceptions Provided by CMS Q1. If I submit a hardship exception application, does that mean that I cannot report on the Promoting Interoperability performance category for Performance Year 2018? No. You may still report on the Promoting Interoperability performance category, and if you choose to report, your data will be scored. If you have a pending or approved hardship exception application and choose to report on the Promoting Interoperability measures, your hardship exception application will be dismissed and the category will not be reweighted. Q2. If I have received a hardship exception for Promoting Interoperability performance category, do I still need to report on the Promoting Interoperability performance category if I am participating in a MIPS APM? It depends on how your MIPS APM Entity requires its participants to submit Promoting Interoperability data. If data will be submitted by individual clinicians participating in the MIPS APM, you would not be required to submit data. If data will be submitted by groups (one submission representing all MIPS eligible clinicians in the practice) participating in the MIPS APM, your group would still need submit data unless all of the MIPS eligible clinicians in the group qualified for reweighting.
Even if you are not required to submit data, you will still receive the APM Entity score for the Promoting Interoperability performance category. Please note, however, that the MIPS Promoting Interoperability hardship exception does not exempt you from reporting on any CEHRT activities required for participation in your APM.
Q3. Will CMS require the submission of supporting documentation along with the hardship exception application? CMS does not require a MIPS-eligible clinician or group to submit documentation with the exception application. CMS will review the application to record the category selected and use the identifying information for each clinician and group listed on the application. Clinicians, groups, and Virtual Groups should retain documentation of their circumstances supporting their application for their own records in the event CMS requests data validation or audit.
Q4. If a practice has multiple office locations under the same TIN, and one office is within a broadband availability area but the other office for the practice is not, would that practice still qualify for the hardship exception (same TIN)? No, the office with broadband availability would not qualify for the hardship exception and, if a practice has an office site with sufficient internet access, the group must report for those clinicians for whom they have data. Q5. Can MIPS-eligible clinicians that have switched CEHRT vendors apply for a hardship exception and have their Promoting Interoperability performance category weight reallocated to the Quality performance category? Yes, if a MIPS-eligible clinician switches CEHRT vendors during the performance period and is unable to demonstrate meaningful use, the clinician may apply for an Extreme and Uncontrollable Circumstances hardship exception within the Promoting Interoperability Hardship Exception Application. For example, if a MIPS-eligible clinician switches CEHRT vendors in 2017 and is unable to submit measures for the Promoting Interoperability performance category for the 2017 performance period, the MIPS-eligible clinician can apply for an Extreme and Uncontrollable Circumstance category hardship exception, before the submission deadline. Q6. What if my electronic health record (EHR) product is decertified? If your EHR product is decertified, you can still use that product to submit your Promoting Interoperability performance category measures if your performance period ended before the decertification occurred. If your performance period ended after the decertification occurred, you can apply for a Promoting Interoperability performance category hardship exception. Q7. What if I’m in a small practice? We recognize that adopting and implementing CEHRT may be a significant hardship for some, but not all, small practices. For small practices experiencing a significant hardship, you can apply for a hardship exception if there are overwhelming barriers to complying with the requirements of the Promoting Interoperability performance category. You do not need to submit documentation of the overwhelming barriers with your application, but please retain this documentation in the event of an audit.
For more details, review CMS’ 2018 MIPS Promoting Interoperability Performance Category Fact Sheet available at https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2018-Promoting-Interoperability-Fact-Sheet.pdf 16 michigan MEDICINE
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Q8. What does the Merit-based Incentive Payment System (MIPS) automatic Extreme and Uncontrollable Circumstances policy apply to?
If you’re located in area impacted by significant natural disasters, such as those designated by a Federal Emergency Management Agency (FEMA) as a major disaster, we’ve tried to lessen your burden by not requiring you to submit an application to reweight the performance categories for MIPS. We are proposing to apply the automatic extreme and uncontrollable circumstances policy adopted for the 2017 transition year to the 2018 MIPS performance period as well as for future years. In addition to the Quality, Improvement Activities and Promoting Interoperability performance categories, we are proposing to include the Cost performance category beginning with the 2018 MIPS performance period.
If we identify you as being impacted by an event, such as those designated by FEMA as a major disaster, you will not need to complete an extreme and uncontrollable circumstances request. We will automatically weight the Quality, Improvement Activities, Cost and Promoting Interoperability performance categories at zero percent of your final score and will assign you a final score equal to the performance threshold, which means you will receive a neutral payment adjustment. We plan to communicate events that qualify for this policy through email, QPP.gov, and other communication channels.
Also proposed for the 2018 MIPS performance period, if a MIPS eligible clinician qualifies for automatic reweighting due to an extreme and uncontrollable circumstance the reweighting is voided by submitting data for the Quality, Improvement Activities, and/or Promoting Interoperability performance categories.
Q9. If I am affected by an extreme and uncontrollable circumstance not included in the automatic policy, what are my options for participation in MIPS?
Beginning with the 2018 MIPS performance period, MIPS eligible clinicians, groups and virtual groups can apply for reweighting of the Quality, Cost, Improvement Activities and/ or Promoting Interoperability performance categories due to an extreme and uncontrollable circumstance. The MIPS eligible clinician would indicate the performance categories that were subject to extreme and uncontrollable circumstance and the impact it had on preventing the clinician from collecting or submitting data for the 2018 MIPS performance period. The application for extreme and uncontrollable circumstances is open from August 6, 2018-December 31, 2018 for the 2018 MIPS performance period.
Q10. What is considered an extreme and uncontrollable circumstance? Extreme and uncontrollable circumstances are events, such as natural disasters, entirely outside the control of the MIPS eligible clinician, group or virtual group that causes the MIPS eligible clinician to not be able to collect information, for an extended period, during the 2018 performance year.
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FEATURE
EHRs and Interoperability: The Fatal Flaw
It’s a brave new world. Or at least that was the idea. In 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act, which included sweeping health care reforms and laid out broad new financial incentives for physicians, practice groups, and hospitals to embrace electronic health and medical records (EHR and EMR). The Act required that by Jan. 1, 2014, providers adopt and demonstrate “meaningful use” of electronic records to maintain their current Medicaid and Medicare reimbursement levels. It also imposed penalties on health care organizations that failed to comply. The idea was simple: create a system where hospitals, specialists, and primary care physicians could easily and seamlessly share information about the patients they have in common. 18 michigan MEDICINE
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M
eaningful use, politicians and policymakers reasoned (and stipulated), would improve quality, safety and efficiency in health care delivery; create more engaged patients and families; improve care coordination and population and public health; all while ensuring the privacy and security of patient health information.
Accomplish that, and federal health care programs would continue scribbling their checks. Fail to get on board by 2015 and watch those reimbursements dwindle. And the “meaningful use” incentive programs did not stop there—multiplying in the years since initial implementation, and making it more important each year for providers to jump on board the EHR bandwagon.
need and a market for a brand-new kind of information and technology expertise around the office.
instant and manageable access to the records they need as they navigate their health care.
While many have relied on new staff or existing partners’ professional development, others in the physician community have taken on the health IT and coding challenges personally.
Very little of that is possible when the computer programs don’t talk to one another.
But even the thirstiest have a hard time drinking from a fire hose. IT headaches are nothing new, but with payers suddenly requiring the use of specific reporting technologies—technologies that remain rife with bugs, glitches, and value deficits—the symptoms have become more maddening and costly.
95%
Downcoding by payers, and confusing or incomplete coding prompts from the EHR systems themselves daily threaten the bottom line of many physician practices.
It’s little wonder, then, that of Critical Access the Office of the National Cohospitals had ordinator for Health Informademonstrated tion Technology reported that And there is another probmeaningful use by 2016 more than 95 perlem. The computer procent of all eligible and Critical by 2016. grams don’t like each other. Access hospitals had demonIn fact, they’re often not strated meaningful use of certified health even on speaking terms. information technology programs. Moreover, 60 percent of all U.S. office-based Michigan’s physician community needs a physicians—and more than 70 percent white knight. IT vendors talk a big game in Michigan—had done the same, with and federal organizations like the Office many more live on an EHR while working of the National Coordinator for Health toward meaningful use. Information Technology are doing what they can, but making a real difference on For physicians, the top priority has always the ground is a role organizations like the been caring for their patients. That is why Michigan State Medical Society and the physicians in every setting and specialMichigan Health Information Network ty were quick to embrace and adopt new have proven better equipped to fill. technology that promised better engaged patients, higher quality care, and more efficiency in health care delivery. Health IT companies flooded the marketplace with flashy new EMR and EHR systems, emboldened by the federal government’s decision to incentivize their services and by physicians’ common pursuit of their patients’ best interests. Unfortunately, the dizzying array of vendors, programs, and iterations inserted a dramatic new learning curve into physicians’ practices. Computer literacy is one thing, but many programs—even to this day—might as well be speaking Latin. Their complexity has also created a
The Holy Grail
Interoperability. For bureaucrats and politicians, it’s a buzz word, but for physicians, their office managers, and their health IT staff, it’s the tech era’s white whale. A quixotic quest. The Holy Grail. The push to achieve it isn’t hard to understand. In a perfect system, physicians would spend less time on the computer and more time treating patients. New efficiencies would create seamless care, healthier patients, and higher reimbursements. All the while, patients could have
The Root of the Problem Just what would interoperability really mean? A patient visits her primary care physician who enters the patient’s data, test results, orders, medications, and other important information into an electronic medical record. When the patient travels across town to see the specialist, that specialist would have access to the diagnosis, test results, and medications ordered by the patient’s primary care physician. Having the single, unified record creates a shorter, more efficient visit with the specialist, cuts costs in the health care system by helping avoid duplicate tests, and streamlines the prescription process. The patient would also be able to access her medical records through an online portal, empowering her to be better educated and to take better control of her own health. It’s a great dream. The reality, though, is all too often a nightmare. Typically, when a patient moves from her primary care provider to a specialist—or a hospital, or urgent care, or any other provider—those additional providers are often on an entirely different EHR or EMR system that cannot easily access (if it can access it at all) the EMR from the patient’s primary care doctor. So the specialist creates or updates another EMR with additional test results, new medications, orders, and other information, on a fresh electronic record that cannot be shared or shared easily with the patient’s other providers in other offices. The offices don’t communicate, and if a patient wants or needs to access her information or test results from home, she could be juggling two, three, four, or even more different providers’ portals. (Continued on page 20)
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The seamless, chart sharing heaven that Washington, D.C. envisioned back in 2009 turned out to be a hellish mash of competing programs, technological silos, and frustrated patients. Alicia Majcher is the Quality Operations Director at the Huron Valley Physicians Association, a physician organization representing 436 physicians across southeast Michigan. Her primary role is to understand all of the incentive programs and critical quality programs with which her member physicians work, and to optimize them for both the best patient outcomes and physician reimbursements. With physicians across HVPA working on a wide variety of EHR and EMR platforms, her job isn’t an easy one. “We are an independent physicians’ organization,” said Majcher. “Physicians make the choice to use an EMR or not use an EMR, and they can make the choice of which EMR is best for their office. “That’s good and bad. If they’ve selected and believe in the EMR they’ve chosen, that will make the implementation process better because they selected it themselves and had autonomy in the matter. On the flip side, everyone having their own instance or ‘table space’ of even the same EMR brings challenges when it comes to interoperability. Our members’ systems are not interconnected because they’re each buying their own instance of that EMR.”
Impact of Poor I.O. on Patients
According to a BMC Health Services Research study published in 2016, lack of interoperability across the nation has created care coordination gaps. Researchers enrolled 29 respondents from 17 organizations in six different regions of the United States in comprehensive focus groups. Researchers identified multiple areas where the lack of interoperability leads to inefficient processes and missing patient data. Researchers found that while health information technology was occasionally used for care coordination activities by each of the providers they studied, the processes were inefficient specifically due to the lack of interoperability.
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In other words, physicians are using electronic health records, but when it comes to coordinating care, these government incentivized systems almost always miss the mark.
“Too much clinician time and energy is wasted searching for, organizing, and reconciling different data sources,” says Monteith.
Scott Monteith, M.D., practices medicine in northern Michigan, at Behavioral Medicine Associates, PLLC. He is also Associate Medical Director for Behavioral Health at Together Helath Network, and a board member at the Michigan Health Information Network (MiHIN), a nonprofit created to coordinate and build bridges between health care providers, and to create the technology and resources needed to make sure electronic health data are more available and effective.
tees errors from incomplete information,” Khoong wrote.
MiHIN is tasked with ensuring effective technology and data models are in place for the electronic exchange of health information, with a patient-centered goal: streamlining the flow of health care information so patients are never far from their personal medical records.
While EHR manufacturers promised higher reimbursements through better templates and more accurate coding, health insurers were taking notice. As higher level Evaluation and Management (E/M) codes increased, insurers instituted more aggressive auditing practices, repricing, and down-coding that threatens every day to impact physicians’ ability to keep their offices’ open and adequately staffed.
Elaine Khoong, M.D., didn’t “We can’t take our eye off the mince words when she de“Physicians are ball on this one,” says Gregg scribed the problem for the using EHRs, Stefanek, D.O., a family American Resident Project practice physician with Gra- but when it comes and MedPage Today’s Kevtiot Family Practice in Alma. to coordinating care, inMD.com. “The multitude “Interoperability would mean these government of electronic medical records sharing medical information incentivized systems make it nearly impossible to that allows providers to make provide efficient, timely, and almost always decisions in real time for the considerate patient care,” benefit of the patients we are miss the mark.” she said. serving. It means providers According to her analysis, lack of interoperand health systems communicating with ability often leads to unnecessary duplicate each other, and demonstrating that we care testing and missing important clinical inforabout giving our patients the best possible mation that can have a direct, detrimental service while keeping them safe.” effect on patients’ health and treatment. Those are goals worth fighting for. “We have a system that almost guaran-
“The fundamental concept of interoperability is that all providers for a given patient will have access to that patient’s health data from all sources,” says Doctor Monteith. “The immediate availability of the entire patient record could provide a more complete clinical picture, improve individual care, and eliminate unnecessary duplication of procedures, such as lab tests.” Physicians and health care professionals agree with the bureaucrats—those are goals worth chasing. But vendors haven’t caught up just yet.
Impact of Poor I.O. on Physicians
Poor or nonexistent interoperability isn’t the only problem physicians have encountered in the government-mandated dash toward meaningful use of EHRs. Problems like upcoding and undercoding can also bite into the practice’s bottom line.
“When EHR first came about, there were EHR vendors promoting their products by telling physicians their EHR would increase revenue for them, would help them code and help them provide a more complete medical record,” said Stacie Saylor, CPC, CPB, a Reimbursement Advocate with the Michigan State Medical Society. Unfortunately, the built-in coding options on many EHR systems came with their own side effects.
With some, automatically-suggested code selections pop up on patients’ records, based on the physician’s input. Other EHRs allow pop-ups with suggested codes that are all-too-often inadequate or mistaken. Some feature diagnosis codes loaded with only a partial or shortened description of the actual code, making it easier to choose the wrong diagnosis, and others auto-fill information from the previous visit, increasing the risk of old or outdated information affecting the code suggestions.
be holding the Holy Grail, but its experts and expertise routinely helps physicians in the Great Lakes State make the best of a complicated situation. Organizations like MiHIN are also on the front lines seeking solutions. This June, they hosted Michigan’s first Meteroic Interoperability Connectathon. The event gave attendees the opportunity to learn, develop, and test applications using Fast Healthcare Interoperability Resources in a collaborative environment with other participants, including organizations engaging remotely, to learn and experience how the new resources can improve workflow and data sharing.
“Automatic or suggested code selection by EHRs has been a big issue for Michigan physicians, and it hasn’t gone unnoticed by health plans,” said Saylor. “For instance, they are seeing an increase in “Automatic or higher level Evaluation and suggested code Management (E/M) codes being submitted, which has selection by EHRs has been a big created audit issues and “repricing” or “downcoding” issue for Michigan issues for physicians.”
They tested data exchange programs exploring patient data queries, consumer-mediated exchanges, public health reporting, and even quality measures.
“Physicians must work together at multiple levels to improve HIT,” said Doctor Monteith, the MiHIN Board Member. “They need to push their local practices, and engage organized medicine such as the Michigan State Medical Society to collectively address our HIT crisis.”
Avoid Overcoding and Audits: Four Questions to Ask 1. Does my EHR automatically allow suggested code selections to pop up based on what the physician inputs?
2. If my EHR is set up to allow pop-ups with suggested codes, does my practice have the electronic capability to override that suggestion and input what
physicians...”
“Repricing” or “downcoding” refers to the process by which health plans review a provider’s codes and declare that they don’t meet the medical necessity for the higher level of E/M. Providers, the insurers reason, have been “upcoding,” and the payers “downcode” to the level they believe appropriate. “The EHR may be picking the level of care based on information that may or may not be appropriate for the visit being billed, especially if the EHR has brought forward history from a previous visit that is not relevant to the current service,” said Saylor.
The Hero Emerges To help physicians navigate the world of electronic health and medical records, and to make the best of a stubbornly independent health IT vendors, the Michigan State Medical Society has published a series of comprehensive physician guides, including their HIT Alert: “Selecting an HIT / HER Vendor that will Meet the Needs of Your Practice.” The Society also makes industry-leading professionals like Saylor available for member and staff consultation. MSMS may not
Groups like these are searching for solutions, and physicians’ wish lists are only growing. Their goals haven’t changed much from the advent of government EHR mandates nearly a decade ago. Neither have the federal government’s. OTC’s report, Connecting Health and Care for the Nation Final Version 1.0, set a goal of nationwide interoperability to enable a learning health system by 2024. Standard formats for sharing data. The ability to send attachments—lab results, radiology, CT scans—between offices and EMR systems. A common patient interface empowering them to take better control of their own outcomes. Developers have their work cut out for them. Thankfully, physicians and physician organizations on the ground here in Michigan are doing cutting edge work to make their jobs easier.
If so, consider turning off this feature.
I feel is the appropriate code?
This is an important feature in any EHR, and a skill you should master to minimize the time spent managing the computer program – and to avoid audits!
3. How are the ICD-10 diagnosis codes loaded, with a full description of the code or a shortened description?
If full descriptions are not given, it becomes easier to choose the wrong diagnosis code.
4. Does my EHR auto-fill information from the previous visit?
If it does, it may contain old or outdate information, or affect the CPT code choice that your EHR suggests.
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EHRs Can Advance Good Medicine If Doctors Are Aware of the Risks David B. Troxel, MD, Medical Director, The Doctors Company
Historically, the doctor-patient relationship has been at the heart of medical practice, with record-keeping and administrative tasks at the border. Today, that critical balance is at risk.
N
early all hospitals and 80 percent of medical practices use electronic health records (EHRs), presumably to help improve access to health information and increase productivity. The problem is that none of these digital tools were designed specifically to advance the practice of good medicine. Consider these stark statistics: Every hour doctors spend with patients, they dedicate nearly two more hours to maintaining EHRs and clerical work. Yet even when physicians are with patients, they’re spending approximately 37 percent of their time interacting with EHRs or other desk work. We are now witnessing the highest levels of physician burnout on record. Indeed, the rise of documentation demands and decrease of meaningful patient interactions has led to major physician frustrations—while making it harder for physicians to deliver quality care. For these reasons and more, the EHR has introduced patient safety risks and unanticipated medical liability risks. According to a new study from The Doctors Company, the nation’s largest physician-owned medical malpractice insurer, the number of EHR-related medical malpractice claims has risen over the past 10 years.
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Factors Behind EHR Errors For the most part, the EHR is a contributing factor in an EHR-related claim and not the primary cause. This and their low frequency (0.9 percent of all claims) suggest that EHRs infrequently result in adverse events of sufficient severity to develop into a malpractice claim. When EHRs are a factor in a claim, the study showed that user factors (such as data entry errors, copy-and-paste issues, alert fatigue, and EHR conversion issues) contributed to nearly 60 percent of claims. As computer users, we all copy and paste. Therefore, it's no surprise that time-pressured physicians embrace the same habits when using EHRs. In fact, the University of California San Francisco Medical Center—today considered a top five medical center in the United States—reviewed more than 23,000 of their own progress notes over an eight-month period and found that, on average, clinicians manually entered just 18 percent of the text in each note, while 46 percent was copied and 36 percent was imported. System factors (such as data routing problems, EHR fragmentation, and inappropriate drop-down menu responses) contributed to 50 percent of claims. EHR fragmentation was among the most prominent system factors, contributing to 12 percent of errors. This factor means that differ-
Contributed by The Doctors Company
thedoctors.com
What the Future Holds As with any challenge of major proportions, progress will take time. But I'm optimistic that the EHR will evolve over the next 5 to 10 years and improve both the quality of medical care and patient safety. Optimizing the EHR will involve: Redesigning EHR workflows to reflect clinical practice workflows in hospital, clinic, and office environments. It is essential that physicians and other healthcare providers be involved in this endeavor. Developing standardized diagnostic and treatment protocols. ent components of a single patient encounter might not be located together in the EHR. Consequently, doctors must check in different places to find laboratory and x-ray results, histories and physicals, etc.—resulting in important information being overlooked or unidentified.
Re-Claiming the DoctorPatient Relationship One overwhelming response to adjust to burdens introduced by EHRs has been the rapid growth of medical scribes. Nearly 20 percent of medical practices are using scribes to help untether physicians from the EHR, with many doctors citing improved efficiency and satisfaction. Yet while scribes can offer great advantages, they can be a double-edged sword. According to a survey of hundreds of physicians from The Doctors Company, the lack of standardized training and variability in experience among scribes poses risks to data accuracy and delivery of care—which could increase liability for the patient and physician alike.
With or without scribes, lowering risk begins with each patient visit. At the beginning of each new session, doctors should inform patients of the purpose of the EHR and emphasize they are listening closely even though they might be typing during the appointment. Practices can set up treatment rooms so the patient can watch the screen and see what is being typed. It is also helpful to summarize or read the note to the patient to demonstrate that you have listened, and ask, “Do I have it right?” If the doctor is using a medical scribe to untether them from their EHR, the same principle applies. Patients must also become their own advocates. They can ask their doctor to read back the EHR notes or review what has been written. Patients can interact with their health record online through patient portals and review their medical record as well as disease-specific educational materials and drug safety information. It is important that they communicate any errors they find as well as personal information updates to the physician.
Researching medical artificial intelligence (AI). This is underway and will doubtless play a significant role in future medical practice. Making EHR interoperability a high priority. Applying “big data” techniques to healthcare. This is underway and, like AI, will lead to new knowledge insights that will change the practice of medicine. Today, what I hear from The Doctors Company’s 79,000 member physicians is encouraging. Doctors are eager to “reclaim” their profession and refocus patient relationships amidst the new demands of today’s digital age. Into the future, new protocols, policies, and training programs must take these small successes to a large scale. For more patient safety articles and practice tips, visit thedoctors.com/patientsafety. The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.
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Educational Offerings MSMS On-Demand Webinars Webinars Offering CME:
Health Care Providers' Role in Screening and Counseling for Interpersonal and Domestic Violence: Dilemmas and Opportunities In Search of Joy in Practice: Innovations in Patient Centered Care
Balancing Pain Management and Prescription Medication Abuse: Chronic Pain and Addiction* CDL-Medical Examiner Course From Physician to Physician Leader
Legalities and Practicalities of HIT - Cyber Security: Issues and Liability Coverage
HEDIS Best Practices HIPPA Security and Meaningful Use Compliance
Legalities and Practicalities of HIT - Engaging Patients on Their Own Turf: Using Websites and Social Media
Human Trafficking* Inter-professionalism: Cultivating Collaboration Medical Ethics – Conscientious Objection Among Physicians* Opioids and Michigan Workers' Compensation Webinar Patient Portals as a Tool for Patient Engagement Pain and Symptom Management Series* Pain and Opioid Management 2017* The CDC Guidelines* Treatment of Opioid Dependence* The Role of the Laboratory in Toxicology and Drug Testing* Michigan Automated Prescription System (MAPS) Update MAPS Update & Opportunities The Current Epidemic and Standards of Care Balancing Pain Treatment and Legal Responsibilities Physician Online Rating and Reviews: Do's and Don'ts Preparing for the Medicare Physician Value-Based Payment Modifier
MACRA Series Key Things You Should Know About MACRA Roadmap for Getting Started MACRA: Alignment Strategy The Role of Documentation Technology Survival Tips to Tackle MACRA Navigating Need to Know Resources MACRA’s Quality Payment Program: Highlights for 2018 Taking Control of MACRA with a QCDR
Billing 101 Claim Appeals Complete Coding Updates for 2018 Compliance in the Office Credentialing
2018 Prescribing Legislation*
ICD-10 for 2017 & Routine Waiver of Co-pays
(part of the Pain and Symptom Management Series)
Choosing Wisely Part 2 - Change Strategies to Implement Choosing Wisely
ICD-10 What We Have Learned & What We Need to Know Managing Accounts Receivable Reading Remittance Advice Tips and Tricks on Working Rejections
*Fulfills Board of Medicine Requirement
Date: Wednesday, October 3 Time: 9:00 am – 2:45 pm Location: MSMS Headquarters, East Lansing Note: Continental breakfast and lunch will be provided Intended for: Physicians, resident, students and other health care professionals. Contact: Beth Elliott at 517/336-5789 or belliott@msms.org
153rd MSMS Annual Scientific Meeting
Coding and Billing Webinars
Free CME Webinars: Choosing Wisely Part 1 - Stewards of our Health Care Resources
A Day of Board of Medicine Renewal Requirements
Morning, afternoon and evening clinical courses available. Date: Wednesday, October 24 - Saturday, October MAPS Update and Opportunities* 27 part of the Pain and Symptom Management Series) Location: Sheraton Detroit Novi Hotel, Novi MAPS Update* Note: Continental breakfast and lunch will be (part of the Pain and Symptom Management Series) provided. Section 1557: Anti-Discrimination Obligations Intended for: Physicians and all other health care professionals Understanding and Preventing Identity Theft in Your Practice Contact: Marianne Ben-Hamza 517/336-7581 or mbenhamza@msms.org
What's New in Labor and Employment Law
Educational Conferences — REGISTER TODAY!
Year-End Wrap Up
22nd Annual Conference on Bioethics Date: Saturday, November 10 Time: 9:00 am – 4:30 pm Location: Holiday Inn, Ann Arbor Note: Continental breakfast and lunch will be provided Intended for: Physicians, bioethicists, residents, students, other health care professionals, and all individuals interested in bioethical issues Contact: Beth Elliott at 517/336-5789 or belliott@msms.org
Visit msms.org/OnDemand for complete listing of On-Demand Webinars. Register online at msms.org/eo or call the MSMS Registrar at 517-336-7581. SEPTEMBER / OCTOBER 2018 |
michigan MEDICINE 27
In Memoriam MEMBERS OF THE MICHIGAN STATE MEDICAL SOCIETY REMEMBER THEIR COLLEAGUES WHO HAVE DIED.
GERALD L. LOPEZ, MD OAKLAND COUNTY MEDICAL SOCIETY 7/16/18 GILBERT B. BLUHM, MD PAST PRESIDENT WAYNE COUNTY MEDICAL SOCIETY 7/29/18
x TO MAKE A GIFT OR BEQUEST: REBECCA BLAKE, DIRECTOR, MSMS FOUNDATION 517-336-5729 OR EMAIL RBLAKE@MSMS.ORG
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28 michigan MEDICINE
| SEPTEMBER / OCTOBER 2018
Practices for Sale 1.5 Million Dollar Pediatric Gross Practice to be OFFERED CHEAP! After many years of practice, the doctor is passing on the torch to someone younger. Must be able to see 60 patients/day or have help. Must be Boarded in Pediatrics. The price is less than $100K. In 25 years of practice sales I have never seen a better buy. Building is being offered for less than assessment as well, flexible terms.
In Memoriam
Bordering Oakland and Wayne County PRIMARY/URGENT CARE Practice with potential to reach million dollar mark per year (again). Call Joe and find out more about what could be your flag ship or second practice! Highly visible, busy road. Set up for success, just need a Primary Care Doctor and maybe a Mid Level. Fabulous New Medical Space Livonia New concept in medical offices with indoor parking, multi-suite and specialty clinics with room for adult day care !! So much is being done with this building. Located central to Botsford, St Mary's, Providence Park. Offered at competitive rates.
Natalia Tanner Cain, MD
Dearborn – General Practice Semi-retired Physician has a 2-3 day practice 20-30 patients per week, $20,000 for practice or free when you lease or buy building.
7/14/2018 Wayne County Medical Society of Southeast Michigan
ENT with mostly Allergy Patients, Westland Hearing aid tenant and small general medicine tenant in building. Buy practice (asking $25K) and rent on short or long term agreement, very reasonable rates. Plenty of room and parking. Rochester hills Urgent Care/Walk In For years a big money maker, recently due to losing major Carriers the Gross is way down and Physician Owner wants to retire. If you are Primary care, have no license restrictions so you can boost this place back up to the Million Gross per Year. Offered Cheap! ( UNDER $100K) Flexible with terms. Near M-59 so can be reached by several communities. Joe 248-240-2141. Pediatrics in Westland near Canton 30 years, high volume, yes it does a big gross! A Pediatrician Physician can work into the practice and take over EARN and purchase transaction. Only a Boarded Pediatrician, potential to earn substantial income. Call Joe for details, Cell: 248-240-2141.
Looking for Part time/Full time Work as a Provider? Different locations available. Call Joe Zrenchik.
Joe Zrenchik, Broker 248-240-2141 (cell) • 734-808-0147 (eFax) bestdoctors@yahoo.com 248-919-0037(office) www.michiganmedicalpractices.com
Thinking about retirement, relocation or expansion of your medical practice? We have buyers and sellers for primary care, internal medicine and cardiology practices.
Doctor Tanner Cain, MD, a member of Michigan State Medical Society and WCMSSM since 1994, has passed away. She taught as a professor at Wayne State University School of Medicine since 1968, and became a full professor in 1992. According to the National Library of Medicine, she was the first African American fellow admitted to the Illinois chapter of the American Association of Pediatrics. However, she faced difficulty joining the Michigan chapter after she moved to Detroit in 1951. Nine months after applying, she was told her application had been misplaced. Finally, she stood up at a meeting and “challenged the members to recognize her.” The chairman introduced her as an applicant member. Doctor Tanner Cain objected and said, “No, I am not an applicant. I am a full Fellow of the American Academy of Pediatrics and I am a transfer member from the Illinois chapter.” Other milestone “firsts” achieved by Doctor Tanner Cain include: 1946: First African American accepted into the University of Chicago’s residency program. 1951: First African American Fellow of the American Academy of Pediatrics; first African American board-certified pediatrician (remove a space)in Detroit. 1952: First African American on Children’s Hospital of Michigan staff. 1983: First woman and first African American president of the Michigan Chapter of the American Academy of Pediatrics
SEPTEMBER / OCTOBER 2018 |
michigan MEDICINE 29
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