GLG News by James Leonard

Implications: Significant decline scheduled procedures. Greater activity in Emergency Room combined with increase in uninsured and underinsured patients. A difficult outlook for Acute care facilities.

Analysis: I completely agree with this article and the conclusions drawn. We see exactly the same situations as noted here. Canceled elective surgeries, even those that are covered by insurance as patient put off non emergent surgeries so as to not absorb their portion of these costs. More so today than ever before, corrective surgeries are looked upon as luxuries that can be done without for now. Putting up with knee pain and foregoing a knee replacement is an easy decision when you are worried about economic conditions that can leave one without income. Even more elective procedures, like Lasik are likely to be hit even harder, wear the glasses and save the dough.

We also see a higher than anticipated ED volume and an increase in uninsured patients, further stressing facilities that already deal with lower reimbursements. Medicare and Medicaid reimbursements and enrollment restrictions severely impact a hospital's ability to continue operations.

In my opinion, the Obama administration can't get here fast enough.

Implications: P$P programs, like CMS Core Measures, while a valuable goal, are primarily about documentation. Documenting the proper activities occurred, within the accepted timeframes is what Core Measures is all about. Did you give the AMI patient aspirin soon enough to be effective, did the pneumonia patient get the correct medication early enough?

Analysis: Pay for Performance initiatives are all about identifying the condition and applying the correct treatment as quickly as possible. This lands smack dab in the domain of Electronic Medical Records systems. EMR vendors like GE, Quality Systems and AllScripts on the Ambulatory side and McKesson, Cerner, Eclipsys and EPIC on the acute care side will be the beneficiaries of the P$P drive in physician offices and hospitals respectively.

Implications: What is the chance of real Healthcare reform in the US when major insurers turn huge profits and support a massive lobbyist effort in Washington? Hospitals and doctors are presented as the main cause for spiraling healthcare costs. As modality vendors release newer products like 256 slice scanners, etc. there is an impression that a 64 slice scanner can no longer provide imagery to properly diagnose.

Analysis: Regardless of the chest beating in Washington, healthcare reform is a pipe dream when insurance companies, turning record profits maintain a massive lobby effort in Washington and the healthcare providers, with limited funds available, are unable to counter their efforts.

As healthcare technology advances, modalities become more expensive, and it becomes a medical arms race to keep up with competitors across town. If you want to capture the more of the MRI market share, you'd damn well better have an equal or superior MRI in place.

As vendors present new technology implants to surgeons, that drives those physicians to request the latest Knee or hip implant, which invariably costs more than the previous implant. As we have recently seen with Ceramic headed hip implants, new and more expensive is not always better.

Implications: A small article that really doesn't do justice to the topic and makes a few misdirected comments.     

Analysis: Real time claim adjudication is more about denial management after the fact than identifying patient responsibility at the time of service, that's really the domain of advanced Insurance Eligibility transactions upon registration.

Point of Service collections can often be tracked down to previous balances with the proper custom reports from many billing systems.

EFT is a banking process, not something to be built into a hospital or practice management system.

Graphical dashboards - yep I agree, this would be great to have directly from your billing system, but easy enough to create in a spreadsheet from existing reports.

PQRI and Clinical reporting has to come from the EMR, not a billing system. Only EMR's manage the clinical data in sufficient detail to report this information effectively to support a Pay for Performance initiative.

Implications: Slow EHR adoption by small to medium sized Physician practices, those with fewer than 100 providers, clearly shows a market niche for a cost effective, Web-based delivery of these systems. This will remove the primary pain point in adoption by smaller practices and groups.

Analysis: Medicare pilot funding aside, there is undoubtedly an urgent need to one of the major vendors to drive to market a purely web-based EHR solution. McKesson's product leaps immediately to mind as one that is purely Web in it's design. Web programing technology allows for very sophisticated capabilities without a "Fat Client" which drives a requirement for higher end PCs in the office. Server side tools; PHP, JSP, ASP provide the capabilty. Unfortunately the vendors take the "easy' way out with fat client development in the rush to get products to market.

Come on vendors, show us what you can do! Stop chattering and make it happen!

Implications: Difficulty in turning the potential opportunity into sales     

Analysis: I'm inclined to agree with the JP Morgan analyst in the thought that the new company will not capture a significant portion of the EMR business represented by the installed base of Misys' Practice Management.

There is thought that Misys customers will adopt AllScripts' TouchWorks EMR at the same rate IDX customers did. Likely not the case considering the somewhat luke warm customer satisfaction of Misys customers compared to IDX and the recent painful news regarding TouchWorks v11 upgrades and new installs.

Implications: Short term pain long term gain? In my opinion, only within the sphere of Misys existing clients. Neither Misys nor Allscripts have been very good at marketing to non-customers.

Analysis: This may cease the erosion of Misys Practice Management (PM) clients to other vendor's Electronic Medical Record products (EMR). I don't see this as upside potential to create a major player in this market. Allscripts had benefited from their marketing relationship with IDX, which went south when GE purchased IDX and that EMR activity went to Centricity. That was a harbinger of Allscripts problems. Allscripts then purchased A4 and proved they didn't have the strength to market to the larger Physician practices. Now they hope to woo investors with additional sales to Misys' existing customers.

The real indicator to watch for when monitoring this new company is how many sales are from outside the existing base of customers. If new sales growth is limited or non-existent, then invest your money elsewhere. Quality Systems' NextGen, GE Centricity and McKesson all have better prospects for growth.

Implications: This is an early indication of a problem that will continue to present itself at hospitals around the country. Two main causes drive this phenomenon: As nursing homes continue to close, there are fewer long term care beds available, which means hospitals can't get their patients out of badly needed beds and the over-use of Emergency care services for non-emergent care creates a bottle-neck at the historical "Front Door" to hospitals. Patients who don't have insurance coverage must resort to using the EMTALA regulations for Emergent Care, to get any care at all.

Analysis: Doctors become more and more reluctant to place discharge orders for their patients who are unable to be discharged to "Home" with no care-giver available. When patients aren't discharged, but don't really need acute care any longer, hospitals are forced to divert incoming patients. There is a critical need in many communities for additional Nursing home or "Step-Down" care beds so that hospitals can free up acute care beds for the patients who really need them.

Implications: Allscripts was a darling while they could show growth of their EMR product over the past years, but a majority of this growth was likely due to their partnership with IDX. Misys has been struggling in the Healthcare marketplace for a number of years, showing no growth and an erosion of their Practice Management client base to market surgers like NextGen (Quality Systems) and GE (Centricity). This is merger is more like two drowning people clinging to one another for salvation.

Analysis: Research should be done to validate AllScripts growth external to their relationship with IDX (purchased by GE Healthcare). It is likely to be uncovered that their growth has gone stagnant now that the IDX business has been absorbed by GE and the IDX client EMR purchases are beginning to swing to GE's Centricity. This is a solid indicator that AllScripts' purchase of A4 was not the salvation they had hoped for. Misys Healthcare direction has been poor for years and this merger is not likely to improve it.

Implications: This is an acknowledgement that a majority of AllScripts' EMR business was generated by their now defunct partnership with IDX. It is also an acknowledgement that AllScript's purchase of A4 did not fill the void caused by the departure of the IDX relationship after IDX was purchased by GE (who have their own EMR (Centricity)).This will slow (not prevent) Misys' departure from the Ambulatory marketplace.

Analysis:  I have been waiting for an announcement of this type ever since GE purchased IDX. My feeling all along was that AllScripts was benefiting greatly from their association with IDX and that relationship was the driving factor behind many of AllScripts' EMR installs. Allscripts attempted to counter the loss of the IDX business with their purchase of A4, but A4 did not have the market share or presence in the Practice Management arena that was sufficient to continue to drive AllScripts' EMR growth (not to mention that A4 had in many opinions a better EMR product than Allscripts). Misys' EMR is a woeful product and they can only benefit from either AllScripts' or A4's EMR expertise, now Misys' PM customers have a decent option for EMR, the proof will be in Misys ability to interface the PM to EMR efficiently. I don't see this giving Misys the ability to grow market share in the PM environment and don't believe they will be a major player in capturing new business. This will likely only forestall (not prevent) Misys' departure from the Ambulatory market.

Implications: It's interesting to note in this article the touting of a technological advance, as if it were cutting edge, while a description of their work-flow "Scan the bar-code to pull up the patient data" clearly shows they've either not implemented PACS at all or have failed at truly integrating the the two technologies.

Analysis: The proper integration of RIS, PACS and Speech Recognition doesn't require the reading of a bar-code, simply calling up the PACS image is enough to provide the speech recognition product with the link to the patient's demographic information providing the interfaces between RIS - PACS and Voice-to-text product was designed properly.