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Jon Mayhew’s company provided the memorable t-shirts for all the attendees at the 2011 Healthcare Summit at Jackson Hole. We had a chance to meet and discuss his unique slice in the healthcare industry dealing with Social Security and disability.

Dodge: Can you describe your business to our readers?

Mayhew: I run a government eligibility company called Freedom Disability. Freedom helps people obtain a Social Security disability benefit; we do this both as a direct-to-consumer product and also on behalf of insurance companies. We have about 20 payer relationships nationally. When we plug into an insurance relationship, there’s a medical cost offset based on somebody picking up their Social Security benefit. Social Security disability benefits will create a pathway to Medicare so it becomes a claims and cost offset to the payer. We have been growing that product for about four years.

We also recently developed Alpha Disability. Alpha is a program that allows us to take service-related veterans and connect them with their veterans’ disability benefit.  Both of our brands are largely directed-to-consumer programs. We do a lot of TV and Internet marketing to develop our client base. Increasingly what we’ve begun to explore with the Alpha product is a significant claims offset opportunity with payers as well.

Dodge: What are the most significant challenges that your business currently faces?

Mayhew: Our largest challenges are growth related. We’ve recently been separated from SSC so we’ve got lots of infrastructure and build-out development responsibility this year. We’re trying to grow our top line by 200 or 300 percent. So, we’re very much in an aggressive growth mode. And being able to get our infrastructure together and get our people hired, trained and structured efficiently while maintaining  aggressive growth objectives are very much our internal challenges. We do feel like the biggest challenges we face are internal versus some of the challenges and implications of healthcare reform. But every time we try to look at what the negative potential implications are of reform, we always seem to counter-balanced our concerns with the huge population, huge opportunity in the marketplace.

Alan Zloto, D.O. is the owner of a private internal medicine practice in Tampa, FL. In the following entry, he weighs in on how healthcare reform is impacting physician practices.

What impact have recent healthcare reform initiatives, such as the HITECH Act, had on your organization?
We’ve had to convert all files to paperless and purchase electronic medical records which included medical billing and scheduling which are all integrated. In addition, our practice purchased tablet PC’s that enable handwriting recognition so all notes are immediately transcribed. This saves transcription costs but also has a learning curve.

How is your organization moving towards meeting meaningful use criteria? What future impact do you feel the new initiatives will bring?
We are awaiting the upgrade of our software which will allow us to comply with all the requirements of meaningful use. We are in the process of assessing whether our security in place will meet the HITECH standards. We’ve enrolled in the Medicare program for reimbursement, but one problem we’ve encountered was getting onto the PECOS system in order to qualify for the reimbursement program. We found that the Medicare website was not user friendly and trying to find someone to help you was very difficult. We had to go to the supervisory personnel before we were able to get on the program.

What is your outlook on the future of healthcare technology?
The outlook for the future of healthcare technology is amazing but also will be expensive and time consuming. In the future, patients will make appointments on the Web, store their medical records on the Web and have access to all their records through the Internet. This may save time in the long run but it will add more time to the physician’s day as he now will need to see patients, make rounds in the hospitals and then answer all his emails from patients.

Are your patients able to communicate with you via email, and how do you see electronic doctor-patient communications evolving in the future?
Currently we do not communicate with patients via email for the reasons noted above. Under meaningful use requirements patients will be able to request their medical information and this will be supplied to them, under federal regulations, within three business days. This will be enabled in our updated software, but is just another form that needs to be filled out.

Alan Zloto, D.O.  is the owner of Town and Country Internal Medicine and has been in private practice for over 30 years. He has a master of public health degree in epidemiology from the University of Michigan and received his D.O. from Michigan State University. Dr. Zloto completed his internship and residency in internal medicine at Detroit Osteopathic Hospital.

 I was fortunate to spend some time with Ric Speaker at the 2011 Healthcare Summit at Jackson Hole. Many of our readers know Ric from his early days at IDX and VERSYSS, and more recently from his eight year stint at Precision.BI. Ric retired last year, lives in Utah, teaches classes at UCLA, and labels himself an “endorphin junkie.” He’s still a triathloner, and this love of extreme workouts gives him yet another perspective on the state of the healthcare industry.

Dodge: Ric, given your retirement last year, give our readers some of your thoughts on the overall healthcare industry, the impact of health reform and what you see as impending challenges.

Speaker: For those of us that have been in this industry a long time—we saw the market freeze during the Clinton administration. Everybody stopped buying and licensing products and the providers said “hold up, let’s see what’s going to go on.” To a lesser degree, I think we went through that too as Obama came in and sort of froze the market. The market now perceives that Obamacare has very little teeth to effectively provide cost savings and virtually all healthcare factions are back to playing their respective roles in a profoundly inefficient market. I don’t have a perfect idea for driving costs out of the market, but I do have a very cynical impression for the government’s political will to have an assertive and positive effect on making it better. It’s such a complex industry—consumers over-consume services, payers provide less value than their margins deserve, provider organizations are operationally inefficient and there’s a lot of cost-shifting going on in an effort to mask real economic structural problems. The government doesn’t seem to grasp the fact that there’s such an acute misalignment of incentives in the industry, and for any effective governmental intervention to succeed dramatic changes to this paradigm with need to occur. For example, recent governmental EMR dollar incentives provide politicians with wonderful fictional hype, but it will have little effect in saving the industry real costs. I think that true, effective change will have to come from within the industry due to forceful demands from informed patients, employers, clinicians, and an independent governmentally tasked business group. We have other insurance based products and services that can used as better examples of risk and reward. The last dilemma facing the industry is the aging baby boomer population that will require increased healthcare services in an environment where there are too few primary care providers.

Ted Wojno, MD is director of Oculoplastic and Orbital Surgery at the Emory Clinic. In the following entry, he weighs in on how healthcare reform is impacting the physician.

1. What impact have recent healthcare reform initiatives, such as the HITECH act, had on your organization?
In keeping with the HITECH Act, Emory Healthcare (Atlanta, Ga.) has adopted an electronic medical record (EMR) and has begun phasing it in over the last year.  As with any major change in a large organization, the conversion has been painful.  From my personal perspective, the losses have outweighed the gains to date. 

• We adopted a “one size fits all” approach.  The EMR system we purchased from Cerner is more of a hospital-based system and more amenable to use by a physician who spends 30-60 minutes with each individual patient such as an internist.  It is not user-friendly to a physician like myself who sees 25+ patients on a Tuesday morning and 50+ patients all day Wednesday and spends the rest of the time in surgery.  The use of the EMR adds one to two minutes to each visit.  This is not significant for someone who spends 30 minutes on a patient encounter but adds one to two extra hours to my day greatly decreasing my efficiency and making my patients wait longer.  The extra time is taken up by the painfully slow “mouse clicking” between pages in the EMR representing previous visits, labs, MRI’s, etc.  Normally this would take only a few seconds in reviewing a paper chart.  Also, one needs to continually keep logging in from patient to patient.
•  In ophthalmology, we draw pictures in the patient chart.  Our EMR does not have this capability so we continue to use paper in the office visit and then have a clerical person scan the visit into the computer.  This has of course, turned out to be very expensive.
• In an effort to speed up the patient flow, the technician now photocopies the last encounter for each patient (office visit, surgery, etc.) and places it in the room for the doctor to see.  This too, has greatly increased our expenses and is a poor use of technician time.
• Prescription writing takes longer on the computer than it does by hand.

In short, since high volume physicians = high profitability, anything that decreases physician productivity will decrease profits (and physician satisfaction).

2.  How is your organization moving towards meeting meaningful use criteria? What future impact do you feel the new initiatives will bring?
We are currently “reporting clinical quality measures and public health data” on all Medicare patients.  The physician asks if the patient is a smoker and if so offers referral for smoking intervention and then documents this in the record in a check box.  We must also check a box that documents that we used the EMR. 

At this point we do not “submit orders” in the Emory Clinic electronically but almost all orders are done electronically at Emory University Hospital.  Again, orders submitted by the physician in the EMR take much longer than writing them out by hand.  This has been a source of great dissatisfaction for many of us.

3.  What is your outlook on the future of healthcare technology?
Clearly the electronic medical record is here to stay.  To date there have been woefully few (if any) good studies that have shown that the EMR has improved physician productivity, decreased overall costs, and decreased medical errors despite glowing reports by the companies that make the software.  Personally, I have erroneously entered more improper medication orders over the last year than in my entire career.  This is simply because it is easier to “point and click” wrong than to accidentally write the incorrect dose for a medication.  I have had several instances where even the drug that showed up on the order was completely different from what I “clicked” on.  Fortunately, all of these errors were picked up by nursing or pharmacy staff.  Often, it has been impossible to understand how the error happened.  It is my impression from speaking with other physicians and nursing staff that medication errors have increased overall.  We would all like to believe that this represents a “learning curve” with the new technology but only time will tell.

On the positive side, it is easier to obtain a complete record of the patient’s history by opening the EMR when I need it.  It has been easier to view radiologic studies on my patients since I can pull them up on the computer and no longer need to walk over to the radiology department.  Again however, for some inexplicable reason, it now takes longer to get some reports logged into the computer and visible on the EMR than it did to receive a paper copy of the report.

Patients now come to the office with their radiologic studies on a CD instead of a folder of films.  It takes longer to “load up” the CD than it did to leaf through the standard type “xray”.  Additionally, there appears to be an unlimited number of software programs in use so the physician must often “learn” how to access the information on the CD.  This is frequently very time consuming and frustrating in the middle of a busy office day.

4.  Are your patients able to communicate with you via email, and how do you see electronic doctor-patient communications evolving in the future?
I do not encourage most of my patients to email me but continue to ask them to call me. It takes much longer to type a response to patient’s questions than to speak the answer over the phone. Often a typed answer from me generates more questions from the patient and we end up with multiple back and forth emails that could have been solved by a very short phone call.

On the positive side, the occasional patient who lives far away can email a picture of “the problem” to me that is better than a verbal description. This is a very small subset of patients. Clearly some of my patients use email to substitute for an office visit (multiple page letters).  If this becomes more routine then we feel that we should be able to render a charge for the time spent responding to them.

My overall feeling at this point in time is that the electronic health record has decreased the time that our ancillary staff spends on issues that used to involve paper and increased the time that the physician spends on those same issues. Since time spent by secretarial and clerical staff is relatively low cost compared to the physician’s time it is so far a money losing proposition. Given the large number of software programs (I use four different programs that have nothing in common at the various hospitals I work at) uniformity would be helpful. For physicians to enthusiastically adopt the technology it must save time and not waste time. That has not yet happened. Big business has done a much better job of selling the government on the technology than providing the physician with something that really works.  All this will of course be meaningless even if the technology does not improve. This is simply because the current generation of physicians in training will never know anything but the EMR and will have nothing to compare it to. They will accept it as “the norm”. 

Ted Wojno, MD is director of Oculoplastic and Orbital Surgery at the Emory Clinic and holds an endowed chair in the department of Ophthalmology at the Emory University School of Medicine.  He has written over 80 papers and book chapters in the field of ophthalmology and given over 100 lectures at local, national and international meetings.

As the healthcare industry discussions continue surrounding the definition of meaningful use for electronic health records (EHRs), others have been seeking to define meaningful use as it relates to more appealing concepts.

Photo credited to Neil Versel’s blog with the original source as Pat Wise of HIMSS.

Looking to get more out of Twitter? Avid users and newcomers alike can easily expand their industry knowledge, stay on top of the latest trends and monitor best practices − all by following the right mix of associations, pundits and experts. Here’s a brief guide to get you started:

1. Healthcare Information and Management Systems Society (@HIMSS). Few PR and marketing professionals in the health IT field aren’t affected by the current dialogue surrounding EMRs, interoperability and the related technologies. HIMSS provides valuable updates on industry events, healthcare reform and a multitude of other topics.
2. Medical Group Management Association (@mgma). If physician practices are part of your target market, this is an excellent resource for staying on top of those issues that impact physicians from a clinical, administrative and financial perspective.
3. Healthcare Financial Management Association (@hfmaorg). By following HFMA, you’ll learn how financial trends are affecting healthcare organizations. You’ll also receive results of recent studies and valuable statistics.
4. Bulldog Reporter (@BulldogReporter). While not specific to healthcare, this is a great resource for B2B PR professionals looking for news and insights to better hone their strategies for generating positive media exposure.
5. Public Relations Society of America (@prsa). As the world’s largest PR organization, PRSA offers tips on educational tools, like webinars and publications, as well as news on issues affecting those working in the field.
6. PRSourceCode (@PRSourceCode). Geared specifically toward PR professionals within the IT industry, this resource provides ways to grow your PR savvy, from Webinars to interviews with editors and industry influencers.
7. HISTalk (@IngaHISTalk). This well-read blog covers a wide range of news and opinion related to the healthcare IT industry and is a great way to hear the perspective of those professionals working in the trenches.
8. iHealthBeat (@iHealthBeat). Compiled by the California Health Care Foundation, this free newsletter combines recent headlines from a variety of news media, including healthcare trades, magazines and daily newspapers. With so much content being written about healthcare IT, it’s a simple way to scan the headlines and make sure you’re not missing something specific your unique interests.
9. The New York Times Prescriptions Blog (@NYTPrescription). Monitoring the constant activity surrounding the proposed healthcare reform is no easy task. This blog from The New York Times is a great all-in-one-source for the latest on current proposals, what they mean for various stakeholders and what the experts have to say about it.
10. AP Style Book (@APStylebook). Keeping up on the latest style rules is much simpler when you follow the AP Style Book. You can even ask the editor a question and receive a response to a specific style question.

Any others you’d add to the list? We’d love to hear your thoughts.

Mark Hagland is a nationally recognized health care journalist, public speaker, and author. More information about him and about his work can be found at www.markhagland.org. In the following entry, he shares a few thoughts about the health care reform that is already happening in America.

With all the heat surrounding the national health care reform debate this summer, it would be easy to lose sight of the reality that what is primarily being talked about in Washington right now is health insurance reform (though with some elements of reimbursement reform mixed in).

And while people of good will might disagree on the best approach to address the enormous health insurance problems in our country, some level of consensus is beginning to emerge on what is sometimes referred to as “internal” health system reform—and that’s a good thing.

By “internal” reform, I mean the kinds of operational and incentive-related activities that take place within and around patient care in hospitals, clinics, and integrated health systems. I mean the innovative work being pursued by pioneer organizations across the country with regard to improving patient safety, patient care quality, clinician workflow, operational efficiency, and cost-effectiveness in care delivery.

I’ve described many examples of such work in my writing for health care professional publications, as well as in the two books I’ve written, Paradox and Imperatives in Health Care (which I co-authored with noted health care economist and futurist Jeffrey C. Bauer, Ph.D.), and Transformative Quality: The Emerging Revolution in Health Care Performance. In addition to shorter descriptions of various types of pioneering work in “internal health care reform” mentioned in those two books, I also provided fully 23 case studies of such work between the two volumes, focusing on organizations like Brigham & Women’s Hospital in Boston, Virginia Mason Medical Center in Seattle, Northwestern Memorial Hospital in Chicago, and Geisinger Health System in central Pennsylvania, all organizations that are doing what needs to be done to improve the quality of patient care and make health care more transparent, accountable, and ultimately affordable, for everyone.

My case studies in both books range from the very broad to the more specific. On the very broad side was my case study on the 44-hospital Trinity Health system, based in Novi, Michigan, whose clinician and IT leaders are engaged in a truly massive effort to improve care quality and efficiency, with intensive health care IT support.

Among other things, the Trinity Health folks have been developing evidence-based order sets that they are standardizing across the entire health system, while also developing standardized clinical process workflows across the health system. Just these two elements alone are remarkable (there are many other aspects of the Trinity Health innovation work), and speak to the vast potential across the U.S. health care system for significant internal reform of the health care delivery nationwide.

Meanwhile, at the University of Pittsburgh Medical Center, a 20-hospital health system in Pittsburgh, PA, intrepid physicians have been creating innovations that demonstrate perfectly the kinds of synergies that can result when clinicians, IT professionals, and IT vendors work together to improve the environment around medication ordering, medication management, and overall access to relevant patient information at the point of care. Working with the Pittsburgh, PA-based dbMotion software company, Dr. Bill Fera and his colleagues at UPMC have innovated a kind of semantic interoperability that, since early 2008, has made it possible for physicians at some UPMC hospitals to pull up all of a patient’s medications and other clinical information (also including lab and radiology results) on a single screen, vastly improving physicians’ ability to make the best ordering and diagnostic decisions at the point of care.

Both of these case studies, along with nine others, are described more fully in Transformative Quality (available via my publisher’s website at www.productivitypress.com). What is strongly heartening for me is that organizations like Trinity Health and UPMC are showing the way forward, even as policymakers debate health insurance coverage and other very important health care policy issues in the coming weeks and months.

And, regardless of the final outcome of the comprehensive health care reform debate taking place in Washington right now, a consensus is emerging among all stakeholders that the “internal” reform that organizations like UPMC and Trinity Health are helping to lead is equally vital and important. I, for one, am looking forward to being able to write many, many more articles and book chapters about such innovations going forward. This is the kind of difficult, yet rewarding, work that health care providers face going into the future. In short, when it comes to “internal health care reform,” the future is now.

No matter what side of the healthcare debate you’re on, keeping up to date on the constant activity surrounding the proposed reform is an overwhelming task. With a topic as complex and significant as this one, even healthcare professionals are challenged to effectively navigate this sea of media coverage and stay abreast of the latest developments.

Fortunately, there’s now a one-stop source for updates on the current proposals, what they mean for various stakeholders and what the experts have to say about it. The Prescriptions blog from The New York Times encompasses everything from the key players in the healthcare debate to a Q&A on how the Canadian health system works to an interactive map showing regional differences in the costs of care. This resource also includes links to related videos, draft legislation and more so you can equip yourself with all of the knowledge you need to stay informed.

Woodcock and Associates is a leading consulting organization working in the medical practice operations and revenue cycle management areas. Today Elizabeth W. Woodcock, MBA, FACMPE, CPC, writes on the potential of Medicare cuts in 2010.

With payments to physicians treating Medicare beneficiaries scheduled to plunge by 20.6 percent starting January 1, 2010, and a depressed U.S. economy, you wouldn’t think there could be any good news ahead for physicians. But the Obama administration has offered a ray of hope – and it could turn into a bright beam of light for physicians. Or not.

There are few specifics so far, but in testimony before the House Budget Committee recently Dr. Peter Orzag, head of the White House’s Office of Management and Budget, hinted that the administration may toss out Medicare’s flawed sustainable growth rate (SGR) formula. Orzag added: “We recognize that we need to move toward a system in which doctors face stronger incentives for providing high-quality care rather than simply more care.”

The SGR helps determine annual fee updates to doctors, but its flawed approach – subtracting per capita GDP from spending on physician services – has produced automatic across-the-board cuts for several years running. Congress always reverses the cuts at the last minute, but next January’s scheduled 20.6 percent cut – the biggest yet – might be too costly to overcome.

Tossing out the formula would be welcome news because private insurers tend to mirror Medicare’s movements. Physicians’ bottom lines are further eroded by consumer-directed health care products – a fancy name for putting more financial responsibility on patients. Unfortunately, patients are a physician’s worst payer. Many patients either can’t or won’t pay larger shares of their health care costs. As the ranks of the uninsured grow, the problem grows worse, bringing even larger write offs.

So far, there are more questions than answers: Will Obama actually eliminate the SGR and boost Medicare payments? If so, what will the new fee schedule look like? Will it be another complicated mess like the initial years of the government’s pay-for-performance program, the Physician Quality Reporting Initiative (PQRI)? Will the economy turn around next year and bring patients the money they need to adequately fund health savings accounts and pay their health care bills? Will insurance coverage be expanded to cover the uninsured – and if it is, will the reimbursement be enough for physicians to sustain their busy, but increasingly unprofitable practices?

The biggest question of all is: How much longer will the current system of private-based health care survive amidst the many downward pressures on physician income? Sure, we’ll always have doctors, but will there be enough of them and who will they work for? As the old radio shows used to say, ‘Stay tuned, folks!’

Atlanta-based Elizabeth Woodcock speaks and writes about the medical practice industry. Book her for a speaking event, or purchase one of her programs on DVD here.