Survey: Physicians are not ready for Quality Payment Program

A recent survey of 1,000 physicians discovered that most respondents aren’t ready for the Quality Payment Program (QPP).

The survey, conducted by the American Medical Association and KPMG, indicates that respondents give mixed views on their comfort level with the program, the proposed rules of which were recently issued for review by the industry.

Physicians this year are measuring and reporting certain quality measures while also indicating proficient use of electronic health records (EHRs) in the MIPS program that is part of MACRA. Physicians can acquire extra points and thus receive higher reimbursement rates beginning in the year of 2019.

Instead of entering the MIPS program, physicians can be part of an Advanced Alternative Payment Model, which will need them to take on risk and receive a 5 percent bonus for meeting certain thresholds that reward doctors for delivering high-quality and cost-efficient care.

In the AMA survey, 70% of respondents report they have started preparations to meet QPP requirements, and about 90% of those believe they will meet the 2017 reporting requirements.

Although, the survey discovered that just 51% were somewhat knowledgeable about MACRA and the Quality Payment Program, and only 8 percent reported that they were very knowledgeable about QPP.

Prior reporting experience through the PQRS and EHR meaningful use programs appears to have contributed to readiness for QPP, survey results demonstrated. However, only one in four physicians say they are well-prepared for QPP.

“Although, even those who feel prepared do not completely understand the financial ramifications of the program,” in accordance with the AMA and KPMG, which conducted the study for the AMA. “In short, they may be prepared to ‘check the box’ of reporting requirements but they lack the long-term strategic financial vision to succeed in 2018 and beyond.” Survey findings are available here.

 

Major industry groups to keenly enhance best practices for mobile app use

3 major provider associations and an advisory firm have devoted to establishing and promoting best practices for mobile app use.

The alliance, known as Xcertia and operating as a not-for-profit corporation, involves the American Heart Association, American Medical Association, Healthcare Information Management and Systems Society, and DHX Group, which works and functions with stakeholders to accelerate development of digital health via industry collaboration. The group seeks more participants, involving developers, consumers, privacy and security experts, and the academic community, among others.

Xcertia will develop and promote best practices for mobile app use selection to foster use of safe, effective and reputable technologies. HIMSS this week debuted Xcertia at its Connected Health Conference at the Gaylord National Resort and Convention Center in Oxon Hill, Md. The alliance hopes to release its 1st content later in the year of 2017.

The driving force behind the step was the need to expand ongoing attempts to foster safe, effective and honorable health technologies to bring clarity and focus to the marketplace, claims Eric Peterson, chair of the American Heart Association Center for Health Technology and Innovation.

The AMA was encouraged to join Xcertia because its House of Delegates has an established policy for the association to assist develop guidance for the mobile space and be part of the digital strategy of the industry, claims Michael Hodgkins, MD, the group’s chief medical officer. “Our significant focus is to make it more convenient for doctors and consumers to choose the right apps.” Those apps, he adds, should be patient-centered, evidence-based and generate actionable information.

Consumers require asking the right questions about mobile app use before buying them, and app developers should support them and provide answers, the AMA asserts. The first job for workgroups will be to look at what kinds of content already are in the market and incorporate instructions, Hodgkins claims. “This is a void that requires being filled given growth in the mobile market and a rapid shift to value-based care.”

Further information on joining Xcertia is available here.

 

AMA strengthens its interactive, geospatial mapping device

The AMA strengthens its interactive geospatial mapping device, made to recognize health professional shortage places and other related workforce trends, to now give population health information by geographic location.

Established in cooperation with the American Academy of Family Physicians Robert Graham Center and vendor HealthLandscape, AMA’s interactive Health Workforce Mapper involves a latest “Population Health Explorer” feature providing information on a variety of population health factors, involving healthcare approach and quality, health behaviors like smoking and alcohol use, demographics, as well as social environment component in which AMA strengthens its interactive and geospatial mapping device.

The AMA strengthens its interactive and geospatial mapping device which can layer data on geographic and health policy data, like hospital locations or health professional shortage places, on top of population indicators, landmarks and other topographical features. The AMA Health Workforce Mapper also can reflect the ratio of physician or non-physician clinician to populations in any provided region or nationally.

Additionally, the device can be utilized by new physicians in closing the gap in sufferer access to care by enabling households and medical students to observe where shortages exist in few medical specialties. By seeking at state, county or metropolitan area information, users can filter physicians and non-physician healthcare experts by specialty and employment setting.

“Making better the sufferer approach to quality care is a primary target of the AMA, and this mapping device will indicate physicians and healthcare experts precisely where their qualities can most benefit populations in requirement,” stated AMA President Andrew Gurman, MD, in a written statement. “Knowing where healthcare services are required most can help providers make the best decisions on where to find or expand their practices to reach patients in greatest requirement of access to care.”

Although, AMA members can analyze a comprehensive version of the mapper that involves the capability to export a customizable Excel file that ranks health workforce and demographic information by county.

To approach AMA’s Health Workforce Mapper, consumers must have Adobe Flash Player 10.0 or higher installed on their computers. The application isn’t compatible with iPhone, iPad, or Android tools.

 

CMS shares information, analysis of vendor-contributor transactions

The Centers for Medicare and Medicaid Services (CMS) on the day of Thursday posted full-year 2015 financial information on its Open Payments website, made to assist clients better understand financial relationships between the proposed physicians and drug and medical device companies.

Better collection and analysis of financial transaction information by CMS sustain its program to detect trends in contributor-vendor relationships and present relevant data to the public. Instead of lauding the transparency attempts, a leading U.S. medical agency inquired the validity of the data, the attempts to observe it and its relevance for clients.

The information accumulated for 2015 involves data about 11.9 million records attributed to almost 619,000 physicians and 1,116 teaching hospitals, totaling $7.52 billion. Under the supervision of Sunshine Act, drug and device companies are needed yearly to report financial interactions with contributors to CMS, which the agency makes public through its Open Payments program.

“Transparency is motivating physicians to be purposeful about their economical relationships with companies, and there is a prominent shift towards charitable contributions and away from other interactions, like honoraria and gifts,” stated Shantanu Agrawal, MD, a CMS deputy administrator and director of the Center for Program Integrity.

Over the course of the program since the year of 2014, CMS has issued 28.22 million records, accounting for $16.77 billion in payments, and ownership and contribution interests.

Besides the 2015 Open Payments data, CMS also issued on the day of Thursday newly submitted and updated payment records for the years of 2013 and 2014 reporting times. In accordance to the agency, the year of 2015 information is the 2^nd second full year of data present on the Open Payments website.

Although, the American Medical Association sustains to take problem with the Open Payments program, calling into question the precision of the published data.

However the AMA says it remains committed to transparency and the availability of data for sufferers to make informed decisions about their medical care, the physician group asserts that the Open Payments information issued by CMS must be valid, reliable, and complete—a bar that it considers remains too high for the agency.

“While we acknowledge the attempts of the CMS to verify the information submitted by industry, continued information errors and registration challenges during the last 2 years have thwarted several physicians from engaging in the review and validation procedure,” in accordance to a written statement from AMA. “The integrity objectives of the Open Payments database will not be met as long as physician review is obstructed by a registration process that is annoying, time consuming and overly burdensome.”

Additionally, the group discussed that “publishing wrong information leads to misinterpretations, ruins reputations and undermines the trust that sufferers have in their physicians,” and “it can also discourage research and care delivery improvements that give advantage to sufferers.”

AMA also stated that it powerfully condemns unsuitable, unethical interactions between physicians and industry. At the similar time, the association made the case that “not all interactions are unethical or unsuitable,” and that “there are relationships that can assist to drive innovation in patient care and offer key resources for professional medical education that finally benefits sufferers.”

 

AMA extending its tech incubator partnerships

The AMA is teaming with IDEA Labs, a technology incubator, to work with students at 5 universities who are establishing new technologies for physicians that take into account how practices really operate.

In various ways, technology has not made healthcare simpler because the technology is clunky and was not designed to support physician practice workflows, says James Madara, MD, CEO and executive vice president of the American Medical Association. Electronic health records are a prime instance, he adds, noting that unlike other industries, “healthcare is not a linear manufacturing process; it is more of a systems engineering issue.”

Another issue with technology development is monolithic—the belief that a product will work throughout a delivery system when it is not flexible enough to do so, Madara notes. “There are institutions that establish their own innovation labs, but while the products are helpful within their walls, they aren’t scalable elsewhere.”

AMA Issues Value-Based Care, MACRA Resources for Contributors

As part of its STEPS Forward program, the American Medical Association (AMA) has issued 8 new educational modules to support healthcare contributors with the transition to value-based care, reported AMA in an official press release.

AMA has established the online resources for healthcare providers to handle the transition to new value-based reimbursement programs that were proposed in the Department of Health and Human Service’s rulemaking on MACRA implementation.

 “With physicians confronting critical decisions about new payment models, the AMA is rolling out tools to assist the practices of all sizes succeed and support better health results for everyone,” stated Steven J. Stack, MD AMA President. “The AMA’s new, comprehensive online resources will assist the physicians to drive successful execution as insurers launch new payment models that reward better results and treatment coordination.”

AMA to Medicare: Begin Paying for Care Coordination in 2012

October 12, 2011 — An influential committee of the American Medical Association (AMA) has issued a challenge to Medicare: If you are serious about the patient-centered medical home, show us the money in 2012.

That group, the AMA/Specialty Society Relative Value Scale Update Committee (RUC), is asking the Centers for Medicare and Medicaid Services (CMS) to start paying separately for certain care coordination services for the chronically ill:

• telephone consults with patients;


• education and training for patient self-management performed by nonphysicians;


• medical team conferences, regardless of whether the patient is present; and


• anticoagulation management.

Right now, such services are generally considered rolled into, and reimbursed under, evaluation and management (E&M) services, epitomized by office visits with established patients. In addition, such services all involve care that does not hinge on a face-to-face encounter between physicians and patients. Organized medicine has long complained that although Medicare pays for the work that occurs in the exam room, it does not adequately compensate physicians for what they do once the patient walks out the door.

The new healthcare reform law aims to solve this payment problem through the medical home, which consists of clinician teams, usually lead by physicians, that will receive a monthly fee for care coordination on top of fee-for-service reimbursement. CMS is testing the medical home concept through pilot projects.

RUC, however, wants quicker, broader action. In a letter to CMS last week, RUC Chair Barbara Levy, MD, asked the agency to begin reimbursing care coordination services for the chronically ill next year on a short-term, piecemeal basis until a more comprehensive approach, such as the medical home, is in place. By doing so, Dr. Levy says, CMS would demonstrate that it "is prepared to incentivize care coordination and foster delivery reform."

While boosting Medicare spending up front, separately reimbursed care coordination services will pay for themselves by eliminating unnecessary office visits, trips to the emergency department, hospitalizations, and prescriptions, she added.

CMS can ignore RUC's recommendations. However, the agency is in the habit of listening to them. It relies heavily on the AMA committee for input when, every 5 years, it updates the relative value units that make up the resource-based relative value scale, which is used by CMS to price physician services.

Codes Already Exist, but Go Unreimbursed

RUC's proposal to CMS is couched in the words and numbers of Current Procedural Terminology (CPT) codes, which are developed and maintained by the AMA for reporting services and procedures performed by physicians. CMS has officially adopted this code set as the means to bill Medicare and Medicaid for physician services.

However, just because the AMA creates a CPT code for a particular service does not guarantee that Medicare and Medicaid will necessarily reimburse it. Case in point are CPT codes 99363 and 99364 for anticoagulation management. The AMA's CPT editorial panel created them in 2007, using 99363 for the first 90 days of such therapy and 99364 for each subsequent 90-day period. In her letter to CMS, Dr. Levy noted that the agency had calculated the reimbursement for the 2 codes ($41 per month for 99363, and $14 per month for 99364), but never authorized paying for them, reasoning that managing someone's warfarin regimen was bundled into E&M reimbursement. RUC is asking CMS to begin paying for these codes on their own.

Other care coordination services listed in the RUC letter also come with codes already on the books:

• Education and training for patient self-management, CPT codes 98960 to 98962: These apply to sessions conducted by nonphysicians such as a registered nurse on a physician's staff.


• Telephone services, CPT codes 99441 to 99443 and 98966 to 98968: These codes are designed for telephone conversations initiated by an established patient that do not originate from a related E&M service within the previous 7 days or lead to an E&M service or procedure within the next 24 hours, or at the soonest available appointment. The first set of codes is for telephone conversations between patients and physicians. When another kind of clinician takes the call, the second set of codes applies.


• Medical team conferences, CPT codes 99366 to 99368: The 99366 code pertains to nonphysicians who confer together with the patient or family members; 99368 is for such nonphysician conferences when patient and family are absent. The 99367 code describes team meetings that include a physician, but not a patient or family members.

Someday, "One Big Code" for Care Coordination

The RUC recommendation to pay for care coordination on a piecemeal basis until the medical home model is in place drew nods of approval from domains of organized medicine beyond the AMA.

"These are short-term fixes, but they recognize the value of work done outside the face-to-face visit, which has not been properly paid for," Lori Heim, MD, who chairs the primary care payment valuation task force of the American Academy of Family Physicians, said in an interview with Medscape Medical News. "[The RUC proposal] could be a real game-changer."

Likewise, Shawn Martin, director of government relations for the American Osteopathic Association, called the RUC recommendations an interim step toward a "comprehensive payment model."

"We're pretty pleased," Martin told Medscape Medical News. "Compensation for services outside the face-to-face visit is a core element of the medical home. Ultimately, you will have one big code for an undefined set of services."

Physicians Adopt Public Safety Policies at AMA Meeting

June 24, 2011 (Chicago, Illinois) — The American Medical Association (AMA) considered the public health implications of bisphenol A (BPA), mercury emissions, and bath salts here at the 2011 Annual Meeting. There commendations of the AMA's Reference Committee E were passed to a standing ovation in an unprecedented unanimous vote by the AMA's House of Delegates.

BPA is widely used in the production of polycarbonate plastics. The AMA's Council on Science and Public Health prepared a report reviewing human exposure to BPA and the federal regulation of BPA. In the United States, BPA is regulated by 2 agencies, the Environmental Protection Agency (EPA) and the US Food and Drug Administration (FDA). Physicians testified that these agencies do not appear to be on the same page when regulating this endocrine-disrupting chemical.

The AMA adopted a policy urging that BPA-containing products be clearly labeled if there is a potential for human exposure. "Both the FDA and Canadian officials have recently expressed concern about potential harmful effects of BPA and taken interim action to protect sensitive populations, such as infants and toddlers, by banning the sale of baby bottles, food containers, and cups containing BPA," said AMA board member Edward Langston, MD, from Lafayette, Indiana. "The policy adopted today supports these measures and a shift to a more robust science-based federal regulatory framework for oversight of BPA."

The AMA also adopted a policy that supports the EPA's national mercury emissions standards for cement kilns. "Exposure to mercury can have adverse affects on human neurological development and is associated with reproductive toxicity and cardiovascular morbidity," said Dr. Langston. The new AMA policy "supports stricter monitoring of mercury emissions from cement plants to lessen or eliminate the potential for Americans to be exposed to potentially harmful levels of mercury."

The House of Delegates also voted to support national legislation banning bath salts that contain methylenedioxypyrovalerone (MDPV) and related compounds that may be toxic. "The misuse of bath salts containing MDPV, mephedrone, and related substances has led to deaths and hundreds of calls to poison centers nationwide," Dr. Langston told Medscape Medical News.

The House of Delegates voted to support the development of written consumer medical information to replace the current framework of patient package inserts. The supporting report on the subject stressed the fact that the lack of availability of useful written patient information is a factor in patient medication nonadherence.

Although the AMA did not pass a resolution on airport security scanners, the physicians did call for more independent research on the health effects of ionizing radiation.

At the meeting, Peter W. Carmel, MD, a pediatric neurosurgeon practicing in Newark, New Jersey, was inaugurated as the AMA's 166th president.

Dr. Langston has disclosed no relevant financial relationships.

AMA Reaffirms Support of Health Insurance Mandate

June 21, 2011 (Chicago, Illinois) — The American Medical Association (AMA) voted to continue its support of the individual health insurance mandate last night at its annual meeting of its House of Delegates, which includes physicians representing all state and medical specialty societies.

AMA president Cecil B. Wilson, MD, spoke at a press briefing after the contentious vote: "We celebrate the democracy of our house and we celebrate that our house came to this conclusion."

Dr. Wilson noted that the AMA has a strong policy in support of covering the uninsured. He added that this vote renews the AMA's commitment to achieve this through individual responsibility for health insurance, and with avenues of assistance for those who need it. The policy advocates a requirement that those earning more than 500% of the federal poverty level obtain a minimum level of catastrophic and preventive coverage.

The AMA believes that the individual mandate is the best option available today to improve access and ensure coverage for the uninsured. The AMA also notes that there is a difference between the positions of the AMA policy that supports individual responsibility and the individual requirement provisions of the Affordable Care Act.

Prior to the vote, the AMA reviewed and evaluated alternatives to the individual mandate and described its findings in a Report of the Council on Medical Services, entitled Covering the Uninsured and Individual Responsibility. The report reviewed AMA policy and advocacy efforts on the subject and summarized the history of requiring individual responsibility. The report was hotly debated in the reference committee meeting on Sunday, and the reference committee made 3 recommendations to the House of Delegates:

• The AMA reaffirms that it is committed to health system reforms that include health insurance coverage for all Americans, and to insurance market reforms that expand choice of affordable coverage, which are consistent with AMA policies concerning pluralism, freedom of choice, freedom of practice, and universal access for patients.


• The AMA reaffirms its policy of advocating that state governments be given the freedom to develop and test different models for covering the uninsured.


• That the report be filed and adopted in lieu of resolutions 102, 109, and 114.

The first 2 recommendations passed easily through the House of Delegates. The last recommendation initiated a 40-minute debate on the House floor related to the nature of the 3 resolutions that were being rejected.

Resolution 102 asked that the AMA continue to support policies that include personal responsibility to participate in private insurance risk-pooling arrangements, such as financial disincentives (penalties) on people who choose to forgo coverage until they are sick.

Resolution 109 asked that the AMA support the use of tax incentives and other noncompulsory measures to encourage the purchase of health insurance, rather than a federal mandate, and rescind the AMA's Individual Responsibility to Obtain Health Insurance Policy.

Resolution 114 asked that the AMA reaffirm policies that provide for an individual insurance mandate, combined with sufficiently financed advanceable and refundable tax credits, as a fundamental part of market-based comprehensive health system reform.

The reference committee heard extensive testimony on all of these resolutions during Sunday's well-attended committee meeting. The debate continued on the floor of the House of Delegates on Monday. Supporters of the individual mandate noted that, in addition to improving healthcare access for the uninsured, the individual mandate would create a private-market approach to expanding coverage and choice, and thereby would promote the growth of the private health insurance market.

Speakers who wanted to modify the AMA's policy on the individual mandate expressed concerns that the AMA's Covering the Uninsured and Individual Responsibility report conflicts with AMA policy that supports freedom of choice, pluralism, free-market economic principles, and preserving the physician–patient relationship. Some physicians also expressed concern that the individual mandate equates with support for increased government intervention and interference in healthcare. Another concern that was raised was the fear that an individual mandate would lead to an increase in the number of individuals who depend on a government subsidy for their health insurance coverage.

The discussion included references to the Affordable Care Act and the Massachusetts health reform effort, both as reasons to support and to reject the individual mandate.

The debate concluded with the testimony of Leah S. McCormack, MD, the delegate from New York, who stated: "I would still give care to patients whether they had insurance or not. . . . There are some things that are more important than healthcare [insurance]. . . . That is the liberty to make my own decisions and not have the government tell me what to buy."

Throughout the debate, many of the physician speakers reflected Dr. McCormack's acute sensitivity to the health consequences of being uninsured and the effect of an individual mandate on personal liberty. In the end, the vote seemed to come down to how to balance these 2 needs.

AMA physicians voted 326 to 165 (66.4% to 33.6%) to reaffirm the AMA's position on the individual mandate. It also voted to reaffirm support for the AMA policy supporting health insurance tax credits and health insurance market regulation, health savings accounts, and direct subsidies for coverage of high-risk patients.

American Medical Association (AMA) 2011 Annual Meeting. Press briefing, June 20, 2011.

AMA: Eliminating claims errors would save $17 billion annually

Claims-processing errors among commercial insurers add an estimated $17 billion in unnecessary administrative costs to the healthcare system annually, according to the AMA, which released its fourth annual National Health Insurer Report Card in conjunction with the group's annual delegates meeting in Chicago.

The 2011 report card is based on a random sampling of about 2.4 million electronic claims for approximately 4 million medical services submitted in February and March 2011 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, the Regence Group, UnitedHealthcare and, for comparison, Medicare, according to the AMA. The claims were gathered from more than 400 physician practice groups in 80 medical specialties in 42 states.The average claims-processing error rate for the six commercial insurers that were analyzed both in 2010 and in 2011 was 19.3% this year—an increase of 2% over last year, according to an AMA news release. That increase is expected to add $1.5 billion in administrative costs over the course of this year, according to the AMA.

Robert Zirkelbach, spokesman for America's Health Insurance Plans, said in an e-mailed response that insurers and providers share the responsibility of improving claims payment accuracy and efficiency. "Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly," he said. "At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate or delayed."

The AMA also found "dramatic reductions" in denial rates for several of the insurers studied. Lack of patient eligibility for medical services remains the most frequent reason for denials, the association noted in the release.

AMA Is Reseller of Cloud-Based Medical Software

May 18, 2011 — The American Medical Association (AMA) has gone into the business of helping physicians go paperless, and qualify for federal cash in the process.

At a Web portal operated by an AMA subsidiary called Amagine, physicians can access software for electronic health records (EHRs), e-prescribing, patient registries, and more, all with a single sign-on, as opposed to a separate user ID and password for each program. As part of the deal, consultants will help customers select and implement the programs. The AMA calls it a 1-stop shop for gearing up to earn as much as $44,000 under Medicare, and almost $64,000 under Medicaid, for "meaningful use" of an EHR.

The Amagine Web portal, built with the help of a company called Covisint, debuted nationally last month after a pilot program among Michigan physicians. It epitomizes "cloud computing," or reliance on Internet-based programs that spare users the hassle and cost of hosting the software on an office-based computer, and keeping the programs updated to boot.

As with other examples of cloud medical software, programs available at Amagine come with no big upfront cost. Instead, physicians can essentially lease them from Amagine, which functions as a reseller. Customers sign up for a minimum 12-month contract and pay a monthly subscription fee, with AMA members receiving a discount ranging from 7.5% to 10%, depending on the product. Amagine advertises that a $300 monthly payment will put someone behind the wheel of an EHR.

Several healthcare information technology (IT) consultants interviewed by Medscape Medical News give Amagine mixed reviews. Although 1 consultant said Amagine may simplify a physician's transition to digital medicine, 2 others questioned the choice of some of the 20 programs on its menu of options.

"Dashboard" Composite of Patient Data

Physicians can choose a mix of programs 1 from 5 categories:

• EHR: Three programs are available, from NextGen Healthcare, Quest Diagnostics, and Ingenix, a business owned by UnitedHealth Group that is changing its name to OptumInsight.


• E-prescribing: The offerings here are Rcopia from Dr. First, CareLab360 Labs and Meds from Quest Diagnostics, and Amagine ePrescribing, said to be "powered" by Allscripts, an electronic prescribing and EHR vendor.


• Revenue cycle management: Infinedi, NaviNet, and AMA PATH provide tools allowing physicians to conduct online insurance verification, transmit claims electronically, estimate a patient's financial responsibility at the point of service, and automate other billing functions.


• Quality reporting and patient registries: Physicians who want to earn "meaningful use" bonuses must report to the Centers for Medicare and Medicaid Services how they manage preventive and chronic illness care for various patient subgroups. Three patient registries called DocSite, WellCentive, and Rcopia-MU help physicians do this.


• Lab ordering and results: The single program in this category — Care360 Labs — allows physicians to submit lab orders and review results online.


• Clinical support: Using the 7 programs in this category, physicians can look up drug interactions, journal articles, and evidence-based diagnostic and treatment advice; order medication samples online; and communicate online with patients.

The Amagine Web portal aggregates a particular patient's data from a chosen suite of these products into a single "dashboard" view. Certain bundles of programs are designed to be interoperable, meaning they can exchange patient information, said Robert Musacchio, PhD, senior vice president of business product solutions at Amagine. Dr. Musacchio told Medscape Medical News that if a physician selects products that lack this kind of data interface, Amagine will create one free of charge, as long as it is a "standard integration."

AMA Receives Commission as Reseller

Amagine states that it gives physicians — confronted with hundreds of medical software products — a pared-down list of carefully vetted vendors that meet its standards for integrity, reliability, security, and user satisfaction. Among other things, the vendors must demonstrate financial stability and focus on office-based medicine, as opposed to inpatient care.

The line-up of vendors, especially those in the EHR category, does not impress healthcare IT consultant Mark Anderson in Montgomery, Texas. "The medical associations I work with don't recommend any of these products," Anderson told Medscape Medical News.

Prominent EHRs that do not appear in the Amagine stable include some that regularly earn number 1 rankings in customer satisfaction surveys conducted by a research firm called KLAS. The latest KLAS ranking by practice size puts the following products in the top spot:

• 2 to 5 physicians: e-MDs Chart from e-MDs;


• 6 to 25 physicians: Greenway Medical PrimeSUITE Chart from Greenway;


• 26 to 100 physicians: eClinicalWorks EMR from eClinicalWorks; and


• more than 100 physicians: EpicCare EMR from Epic.

Anderson said the EHRs offered through Amagine have their good points but suggested that financial considerations may have weighed heavily in their selection. He noted that some organizations have endorsed EHR products because vendors were willing to "pay to play" — that is, simply buy an endorsement. Healthcare IT consultant Barb Drury in Larkspur, Colorado, voices similar concerns. "There has to be a business reason [for both sides]," Drury said.

Dr. Musacchio said Amagine is not a pay-for-play marketing venture. "[Vendors] don't pay us to be on the site," he said. One financial consideration that does affect vendor selection, he noted, is the commission that Amagine earns for reselling subscriptions to online programs. If a company proposed too low of a commission, "it wouldn't be economical for us to sell its product on the portal," he said.

Dr. Musacchio said Amagine would be adding more products to its line-up. He noted that some prominent EHR vendors initially did not meet the technological criteria set by his company. "Since then, things have evolved," he said. "Now that some of the technological issues have been worked out, you'll see more products come aboard in the future."

At the same time, said Dr. Musacchio, Amagine cannot do business with everyone, nor should it attempt to. "We want to give physicians a choice, but we're not aiming for an infinite number of choices," he said. "Otherwise, that would paralyze a physician's decision-making."

"Trusted Source" vs Typical Vendor

Rosemarie Nelson, a healthcare IT consultant in Jamestown, New York, who is affiliated with the Medical Group Management Association, also sees a benefit in a limited field of products.

"What Amagine is saying is, 'We're going to simplify the deal,' " Nelson told Medscape Medical News. "It would appeal to a lot of practices that are overwhelmed with the decision points."

Nelson said that practices unsure about selecting and implementing the technology could benefit from Amagine's consulting services as well. Those consultants, according to Dr. Musacchio, represent a combination of Amagine staff and third-party companies that provide a regional presence.

Amagine's consulting arm reinforces the company's role as a technology reseller. Customers do not have a direct relationship with any of the software vendors whose products are on the Amagine platform. "They have a relationship with us," said Dr. Musacchio. As a consequence, if they experience a problem with their software, they would turn to Amagine for assistance.

Nelson said Amagine may win customers as a "trusted source," because of its AMA roots. However, Barb Drury advises physicians to keep up their guard and treat Amagine as they would any other vendor. She recommends that they study the terms of use and related business documents at the company Web site, found by clicking on the "Legal" link at the bottom of the page.

Senate Bill to Put Physicians & Medicare Billing Data Online

April 9, 2011 — How much individual physicians receive from Medicare for treating seniors on a service-by-service basis — level-4 office visits, vaccinations, chest x-rays — would be posted online for all to see under a bill introduced April 7 by Sen. Charles Grassley (R-IA) and Sen. Ron Wyden (D-OR).

The 2 senators contend that public disclosure of billing information would help citizens and consumer watchdog groups spot Medicare fraud, waste, and abuse — and also deter clinicians from engaging in it.

"I believe transparency in the healthcare system leads to greater accountability," Sen. Grassley said on the Senate floor. "I’ve often quoted Justice Brandeis, who said, 'Sunlight is the best disinfectant.'" Accordingly, he and Wyden titled their legislation the Medicare Data Access for Transparency and Accountability Act.

The American Medical Association (AMA) counters that physicians deserve privacy when it comes to Medicare billing. Furthermore, it argues, government entities charged with combating Medicare fraud, such as the Department of Justice and the Office of Inspector General of the Department of Health and Human Services, already have access to the data. The plan to post a physician’s National Provider Identifier number along with the billing information could "put physicians at significant risk of identity theft," said J. James Rohack, MD, the AMA's immediate past president.

The proposed government Web site would contain Medicare billing data for all providers and suppliers, not just physicians. The Senate legislation requires it to be searchable, including on the basis of individual items and services. The public could access the site free of charge.

The legislation comes in the wake of a series of stories published last year by the Wall Street Journal based on an analysis of a limited amount of Medicare billing data. The stories spotlighted a number of physicians who received more than a $1 million a year from Medicare by performing an unusually high number of diagnostic tests and surgeries for seniors.

Sen. Grassley acknowledges that sheer volume for a particular service does not necessarily mean a physician is engaged in shady business. Rather, he or she may be a leader in that field, attracting more patients as a result. His legislation requires the billing-data Web site to state upfront that the information does not reflect on the quality of the service or the clinician who provides it.

The controversy over public disclosure of Medicare billing information goes back to the late 1970s, when the old Department of Health, Education, and Welfare sought to publish a list of all clinicians who treated Medicare patients and what they earned from it. The Florida Medical Association and the AMA asked a federal district court in Florida to issue an injunction blocking publication of the list, and the court obliged in 1979.

Dow Jones, the publisher of the Wall Street Journal, filed suit in that same federal court in January and asked it to lift the injunction. The case is pending.

AMA launches coding mobile app

The American Medical Association unveiled a coding application for use on Apple iPhones, iPads and iPod Touches and also announced a contest to find "the next great medical app," according to a news release from the association.

The CPT coding app is free on iTunes and is designed to help physicians find appropriate evaluation and management billing codes—known as E/M codes—which apply to patient-physician encounters.

The AMA also launched the 2011 AMA App Challenge, which asks physicians, residents and medical students to develop innovative medical applications. Two winners—one a physician and one a resident, a fellow or a medical student—will receive $2,500 in cash and prizes and a trip to the AMA's annual meeting in November in New Orleans.