We should be concerned that the forthcoming MINIMUM cybersecurity standards will lead to many organizations being even less prepared than…
News 12/27/23
Top News
Constellation Software acquires EHR provider Medhost. Terms were not disclosed.
Medhost will be operated as a standalone business under Constellation’s Harris software group, where it joins Altera Digital Health, Amazing Charts, QuadraMed, Iatric Systems, Picis, and several other acquired health IT companies.
Reader Comments
From Oracular Degeneration: “Re: Oracle Health. The former Cerner was blamed for missing revenue expectations. Expect license audits to follow.” Oracle is somewhat famous for turning innocent-sounding “license audits” into a sales channel, where the company collects customer usage information (voluntarily or otherwise) in coordination with a sales rep and then demands that the customer buy more licenses to avoid legal action. Palisade Compliance describes how the city of Denver was rushed into paying Oracle $4 million under an Oracle program that Palisade calls ABC audits (audit, bargain, cloud) in which the company forced the city to buy cloud services to avoid legal actions. NASA recently bought $15 million in unneeded Oracle software in fear that the company would find something amiss. Former clients of Cerner may be running under old contracts or those that weren’t prescriptive about M&A, hardware upgrades, virtualization, or moving services to the cloud, so it might be prudent – especially for any contracts that involve processor-based metrics – to assess your situation before Oracle does.
From Adapt or Die: “Re: changes at my primary care practice. They will now require holding a credit card on file, charge a $15 annual cash fee for services that insurance does not cover, and limit annual physicals to health screenings and risk management with no review of specific medical issues.” These changes seem entirely reasonable, although I would be nervous about leaving a credit card number on file given the unpredictable nature of the amounts and timing of physician billing. This practice says that the patient usually receives the EOB first and has time to resolve problems with their insurer. When the practice’s business office receives their copy of the EOB, the patient’s balance will be billed via InstaMed. Leaving a credit card on file is dangerous for the many or most Americans who can’t afford to pay unexpected (or even expected) medical bills, but patients who can’t afford to pay their legitimate healthcare expenses aren’t the practice’s problem. This state of affairs must be puzzling to the rest of the developed world that can’t understand how we allow every profitable aspect of healthcare to be milked financially by publicly traded companies, zillion-dollar health systems, and private equity firms. The status quo remains in place only because we peasants aren’t all sick at once and thus haven’t charged the healthcare castle carrying torches.
From VTViper: “Re: ModMed. Huge layoff last week. The entire podiatry team was let go.” Unverified.
HIStalk Announcements and Requests
Only 10% of poll respondents expect Oracle Health to be the owner of an improved former Cerner business in five years, with more than half expecting the company to sell or close most of it. Commenters note that Oracle will milk the business solely to keep VA/DoD taxpayer dollars flowing and ponder why David Feinberg is still pocketing millions with few signs of serious job responsibilities.
New poll to your right or here: Did you receive a holiday gift from your employer? My theory is that big-employer gifts are rarely more than a check-the-box effort (company-branded merchandise, a low-value gift card, or a box of candy), although individual bosses may go above and beyond to recognize their employees more personally. My experience is almost entirely within health systems, where the number and diversity of employees ensured low-effort corporate swag like a mug or tote bag. I have mixed feelings about the alternative of department pizza parties, which are tacky on the surface but often slightly fun for those whose schedule and location allows them to attend.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Acquisitions, Funding, Business, and Stock
Harris Healthcare-operated Altera Digital Health petitions the bankruptcy court of Mercy Iowa City over the hospital’s planned transition to a new EHR upon completion of its acquisition by University of Iowa. The hospital, which partly blames the former Allscripts software for its poor financial condition as its AR jumped 40% after implementation, told Altera that it will be cancelling its agreement but requires access to company support through early 2025. Altera wants the court to either force the hospital to honor its existing agreement that runs through 2031 or declare it void. The company says the $8 million “cure amount” of the existing contract is insufficient and wants $12 million plus damages that are accruing at $207,000 per week.
Apple stops selling its Series 9 and Ultra 2 smart watches due a US International Trade Commission decision that the Watch’s pulse oximetry technology infringes on patents held by medical device maker Masimo. Apple has filed an appeal.
People
Baylor Scott & White Health promotes Nathan Winn, MPA to VP of IT.
Announcements and Implementations
NPR addresses the “why do doctors still use pagers” question, with these observations from doctors who led a failed hospital project to replace them in the ED:
- Pagers, as a 1980s relic from the Sir Mix-a-Lot days that even drug dealers have abandoned, should be easy to displace. Doctors don’t like receiving pages that contain only a phone number with no hint as to who they’re calling or what that person wants. Pages also can’t be verified as received. On-call residents are handed a pile of team-specific pagers for their “Rambo belt” and need to track down which one is beeping.
- However, pagers are “the cockroaches of communication” because they are cheap, nearly impossible to damage, run forever on a single AA battery, and are more reliable with fewer dead spots since they don’t use cellular networks.
- Doctors worry that patients will think they are screwing around if they look at their phones during a visit to read a message, but with a pager, “they know you’re doing doctor work.”
- Smart apps make communication among doctors too easy, where the sender doesn’t worry about bothering a colleague or phrasing a request succinctly
- Pagers provide control, or at least the illusion of it, as even junior residents can decide when and how to respond without the sender knowing if they have seen the message.
- A management professor says that technology isn’t just about the tools and instead is a project that involves RHIP (pronounced “rip”) – risk, habit, identity, and power. Doctors were being asked to change their routines, the change made them feel differently about their jobs, and it shifted power.
- The result was that the pager replacement system failed to reduce patient time in the ED, partly because the existing system was already efficient and also because many doctors had stopped using the new devices.
Other
A small, single-hospital study finds that inpatient satisfaction scores increased if their room’s guest chair was placed near the patient’s bed to encourage doctors to sit while visiting, which the authors call a “chair nudge.”
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“Credit Card on file”???
“Credit card on file”??
I was thinking about this recently since I just completed an registration form for a dentist office I will be visiting. They wanted my SSN number and I left it blank. I told them no SSN info unless they signed an agreement with me that stipulates that if they get hacked they will pay for ALL costs of my ID recovery and related insurance thru LifeLock. No response as yet…
Has anybody seen/drafted such a document?? We sure need one!
Credit Card on file works well if used appropriately. We do this with many practices. In our EHR, you can indicate a max amount to charge in a single month or transaction, with a lifetime/annual max. We have clients who send statements with a dunning message that if they have a card on file, this balance (up to their approved max) will process in x days. Others do as the writer states above, expect patients to actually read their EOBs and know what their out-of-pocket is. Credit cards are stored securely, so this should not be a worry. I encourage everyone to get on board, it is making collecting patient AR a non-issue. Note that in the past, if you were on a payment plan with your doctor, some biller wrote your card info down, put it in a day of the month sorter, kept it in a drawer or cabinet, and manually entered the info on the day you agreed every month. This was the process for decades, and I’ve ripped those sheets out of desperate billers’ hands to shred them. Confirm your provider has the ability to hold a secure electronic card on file and do it!
Credit card on file? Never if I can help it. I’d look for another clinic first. With the billing and coding errors I’ve dealt with over the years, I always want to be in the position of them coming after me for money rather than the other way around. Same reason I always decline to prepay the deductible when I show up at registration.
“limit annual physicals to health screenings and risk management with no review of specific medical issues” is so corrupt it makes me see red.
I started hearing about this a year or so ago and figured it was a mistake, then my own doctor’s office started doing this and I want to start calling Attorneys General to see what the deal is. From my perspective this is double-dipping: the *purpose* of the ACA requiring an annual physical at no extra charge was specifically to make sure that chronic conditions are managed appropriately so that they don’t become acute and drive up the cost of care. “No-copay” eliminated a financial barrier, to get people into the doctor’s office specifically so that these conditions could be treated Charging extra – both by billing the insurance company for a separate visit which exist concurrently with the physical and collecting a copay – once the “annual physical” actually turns up a new diagnosis, completely eliminates the benefit of the no-copay-wellness visit. Its absolutely the alpha and omega of perverse incentive.