CMS Administrator Seema Verma has warned that data blocking will not be tolerated.
“Finding creative ways to trap patients in a system must end. It’s not acceptable to limit patient records or to prevent them and their doctor from seeing their complete history outside of a particular healthcare system.”
As information systems tools and datasets for healthcare proliferate, interoperability is critical to enable transitioning to the next stage of American healthcare delivery. Data sharing among disparate practice management and EHR legacy systems is critical to realize the benefits of integrating new tools into the clinical setting. Companies may be more inclined to share under the pressure of government and business incentives. Because so far, integrated physician groups haven’t been able to get their software systems to play nice in the playground.
Physician integration and alignment depends on data access and report generation
The need for aggregated data that cross the silos of multiple health record systems, practitioners and healthcare settings is often impossible. For integration to work as intended, it is imperative that the current generation of digital health solutions allow physicians to realize their potential. The problem is information management vendors don’t want to collaborate and may have simply crossed their arms across their chests and said “no”. They are hoarding the data because that’s how they are generating revenues. They lowball the price of their software to get in the door and then hoard the data and layer themselves in for a cut of billings and revenues. With the collaboration we need, those walls are penetrated and they risk redirection of that revenue they counted on in the face of the lowball price tag to some other entity (an MSO, for example) or another vendor.
As physicians move to value-based contracting, EHR vendors and practice management software vendors risk an all or nothing bet.
With the move to value-based payment models, providing clinical or predictive patient insights to providers and insurers can increase the importance of a dataset. But if the physicians have had their fill of resistance and limitations the EHR vendor may risk going from some berries in the pie to no pie at all. Physicians are missing out on hundreds of thousands of dollars in bonuses and levied fines and penalties while paying for a system that can but won’t do what they need to collect their hard-earned bonuses and avoid the penalties and fines. It is the prelude to a replacement.
Physicians don’t have the time, wherewithal or patience to fight with software suppliers. They just call someone like me and say “I’ll pay you to be my advocate and find me something else. I have patients to see and I can’t be bothered.”
In my role as their advocate and consultant, I am not influenced by commissions and finders fees. I am compensated to perform a task and narrow down the list of candidate vendors to a short list. Most software vendors are on edge when they interact with me. First, I don’t want to see how easy it is to enter patient demographics. The doctor will hire someone to do that at a much lower pay grade who needs to see that. I want to see the contract for service, maintenance, collaboration with other component vendors, and will be scrutinizing business models that focus on percentage of revenue splits. I want to see report generation and data sharing that will be required to operate an integrated healthcare entity to the highest level and value. I am what one would call an “advanced shopper”. The typical sales pitch rep should tremble before an appointment with me. The right vendor is going to grin ear-to-ear and say “I’ve got this!”
I am going to ask deep probing questions that arise from my experience at health plans, in contracting, as a former billing service owner, as a former practice manager, former executive director of several IPAs, MSOs, etc., and as the designer of the world’s first and only Globally Integrated Health Delivery System®, a trademark registered in 2010 and perfected over the past 8 years.
I am going to test it for predictive modeling so that the my client can view itself from the perspective of the health plans with whom they contract. I’ll be viewing their outputs and data sets as an asset across organizations that facilitates integration and alignment through a rich ecosystem of innovations from bundled pricing and cost data to new innovations that differentiate entities that are, at a minimum, adherent to national standards and FHIR-ready. If the vendor reps don’t come with sample reports and query request sheets in hand, they should stay home or at the office, because I won’t be charging my client for hours and hours of follow-up and telephone tag. I’ll just cross them off the list and interview the next one with what I need in hand at the first meeting.
And for vendors who have the business model of a charging beyond licensing at a hefty percentage of fees for billing and accounting, who want 15% to 30% of revenues, let me explain: “pigs get fed, hogs get slaughtered.” Show me, instead, what it will cost to implement APIs that make data available across disparate systems. That will get you an appointment with my clients at the decision-maker level. Otherwise you get me and I cut you then and there on the first meeting. You won’t progress to the next level if you won’t collaborate.
And if you are blatant about data blocking, don’t think I won’t make a call to Ms Verma’s office and have them open an investigation. I like hamburgers made from sacred cow meat. The 21st Century Cures Act, signed into law by President Obama, encourages interoperability of EHRs and patient access to personal health data. It discourages information blocking. President Trump’s administration issued guidance for providers about how to attest they are not engaged in data blocking and are willingly sharing information across silos and with patients. If you have an appointment with me, you’d be wise to prove to me that you are compliant with the Cures Act.
To differentiate their professional brands, my clients are actively seeking innovative ways they can use data they’ve created in their EHRs and practice management systems. The common need for data access will drive up integration, alignment, value, quality, and efficiencies. Open architectures and business models that provide for sharing and interoperability instead of human manipulation of data into reports will be rewarded as they help doctors, dentists and health facility administrators create new value out of insights that can be generated from the data. If you hold my clients back, I guarantee that you will be punished as you watch them switch vendors.
About Maria Todd
Maria Todd is a consultant and author who provides physicians, dentists, and health facilities with advanced and effective managed care negotiation and strategy development in the USA. she is the author of the Managed Care Contracting Handbook, 2nd edition; IPA, PHO, MSO Development Strategies; Physician Integration and Alignment: IPA, PHO, MSO, ACOs and Beyond; and the Physician Employment Contract Handbook, 2nd edition. She consults to more than 4000 hospitals and physicians in the USA and abroad and has presented over 2600 educational workshops and seminars on managed care, physician integration and alignment, with 1st quartile reviews on all speaker metrics and post seminar evaluations.