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Tuesday, April 9, 2013

Meaningful Use attestations thus far by vendor

Hat tip to Government Health IT.
Trends in EHR vendor strength in 6 charts
April 08, 2013, Robert Rowley, MD, Healthcare and health IT consultant, practicing family physician
On April 2, 2013, the federal Centers for Medicare and Medicaid Services (CMS) made available their updated data table for EHR Incentive Program (Meaningful Use) attestations, with specification as to which EHR products were used. The initial file, published on in 2012, showed the first year of experience of Meaningful Use, and allowed the relative comparison of vendors in the EHR arena.

The data table disappeared from the site in the middle of 2012, but has now been updated and re-posted (after some prompting at last month’s HIMSS conference). The updated data shows all the Meaningful Use attestation to date, and can show both first-year attesters for 2011 and also 2012, as well as second-year attesters in 2012 who started their first-year attestation in 2011. Given that this comes from actual reported Meaningful Use attestation to the government (for the Medicare version of the program), it is arguably the most accurate source, free from vendor hyperbole.

So what kinds of observations can be made from a preliminary analysis of this data? Which vendors are gaining ground, and which ones are sinking? Are doctors switching from one vendor to another?...
Four of the 6 charts:

I'd be careful in making too much of 2011 vs 2012 "trends." A lot of the "466 remaining vendors" came on line with ONC-CHPL Certified EHRs and modules at decidely different times. It would seem only natural that they would gain nominal aggregate market share relative to the legacy 800 lb Gorilla Epic. All the moreso since they're unlikely to be products aimed at going head-to-head with Epic

I was up in Reno when these latest data became available. I've not yet had time to drill into them in search of other empirical ore veins and nuggets.

But, I will.

Dr. Rowley concludes on this note.
The newly released data by the federal government on Meaningful Use (at least, the Medicare option – the Medicaid option is managed by each state, and therefore no centralized data is currently available) provides a rich data set for analysis.

Relative market strengths among EHR vendors are noteworthy for EHR users, for institutions, and for investors. A more thorough analysis of this data will be forthcoming.

UPDATE: #EHRbacklash bite
Does meaningful use help you in any measurable way?The meaningful use requirements themselves do not help me care for a patient in the room.  Again, I’m speaking to you as a physician, but as we go through the whole process, we all recognize this is coming from CMS, and we understand the long-term goals of EHRs, and that we want to be able to define better levels of care.  If you ask any physician how they like their EHRs, they’ll say “I hate them all.”...

...I’ll be frank and say there are aspects of the meaningful use attestation requirements that I don’t completely understand...

RENO, Nev. (KRNV and - News 4 is still waiting for the chance to sit down with Renown's President and CEO Jim Miller to talk about the recent investigation by the FTC and a lawsuit filed by a group of local cardiologists.

As we reported in a recent Fact Finder investigation, multiple sources tell us the cases and purchases cost Renown at least $15,000,000. While the man in charge at Renown has not been willing to talk to us about it, the hospital has put out a website to challenge some of the facts in our stories.

We discovered the website on our own and were not told about it by the hospital, but because we want to be transparent in all of our stories. News 4 wanted to share with you some of Renown's response...

Pretty interesting stuff. Gotta love the Infographic at

Pay attention to the first two items.

"Critical compensation schedules" were MISSED?

By the lawyers? Not to mention the top brass at Renown. What are you paying these people for?

And, you would have us believe that this "critical" element was missed as well by the sellers' Counsel? Seriously?
NOTE: As of 7:57 a.m. PDT April 10th, 2013, there were no statements of "copyright" of any kind on this Renown website. I guess the Very Busy lawyers missed that too. Should that "oversight" get corrected post hoc and I be commanded to stand down for Stepping on Their Sidewalk Without an Escort, too late; I've already saved every page to disk for the record.
The Heart of the Matter website is intended to share our side of the story and development of the situation.

As detailed on the site, due to national changes in the healthcare landscape under the Affordable Care Act (ACA), many physicians in private practice nationwide are looking into and moving toward hospital employment. It is against this backdrop that both Sierra Nevada Cardiology Associates and Reno Heart Physicians first approached Renown for employment – many of which had indicated they did not believe they have many other options for employment in the area.

Regarding the missing compensation schedules within the contract, it is truly unfortunate that lawyers from both sides did not notice this critical piece of information was missing when the contracts were signed. Virtually everything else that happened started because of this breakdown.
Yeah, it's Truly Unfortunate.

More like egregiously negligent, incompetent. If it's even true. I may have been born at night. but it wasn't last night. 'Oh, a mere unfortunate oversight.'

Right. Hey, it was only about the trivial matter of compensation.


Word is that a lot of people failed to get the joke. 

A bill in Congress has people talking about meaningful use exemptions
Ed Burns, April 10
Representative Diane Black (R-Tenn.) introduced a bill into Congress on March 21 that would provide significant exemptions from the meaningful use rules. While the bill isn't expected to go far legislatively, it may help draw the attention of regulators to persistent problems faced by specific groups of physicians.

The EHR Improvement Act would provide meaningful use exemptions for solo practitioners and physicians who are at or nearing retirement age. Other provisions would provide rebates for payment adjustments made against physicians who subsequently meet the requirements of meaningful use, allow specialty physicians to satisfy meaningful use provisions by participating in registries, and bring rural health providers into the meaningful use program after 2014...

"While the bill isn't expected to go far legislatively, it may help draw the attention of regulators to persistent problems faced by specific groups of physicians."

Well, I think the "regulators" already know of these problems. But, if you spend any time skulking around down in the  comment/response sections of the myriad HHS Final Rules, you see repeated beg-offs pointing out that the CFR writers cannot go beyond the scope of the referent legislation. This is proper, too. Congress gets to write laws, not unelected "regulators," whose legitimate role is to promulgate the operational "rules of the road" that map back to the original legislation.

Not that the distinction is always so clear in practice.

Prominent Tri-State Cardiologist Admits Record $19 Million Billing Fraud Scheme, Exposing Patients To Unskilled And Unnecessary Medical Treatment

April 10, 2013

NEWARK, N.J. – A well-known cardiologist and the founder, CEO, and sole owner of a pair of large medical services companies in New Jersey and New York admitted today to conspiring in a multimillion-dollar health care fraud scheme that subjected thousands of patients to unnecessary tests and potentially life-threatening, unneeded treatment, as well as treatment by unlicensed or untrained personnel. The guilty plea was announced today by New Jersey U.S. Attorney Paul J. Fishman.

Jose Katz, 68, of Closter, N.J., pleaded guilty before U.S. District Judge Jose L. Linares in Newark federal court to an Information charging him with one count of conspiracy to commit health care fraud and one count of Social Security fraud arising from a separate scheme to give his wife a “no show” job and make her eligible for Social Security benefits.

As part of his plea agreement with the government, Katz agreed that the loss amount sustained by Medicare, Medicaid and other insurers victimized by the fraudulent billings was $19 million. U.S. Department of Health and Human Services, Office of Inspector General and FBI records indicate the loss amount suffered by the victims is the largest recorded in New Jersey, New York and Connecticut for an individual practitioner convicted of health care fraud.

“After years of prominence in his field, Jose Katz will now be remembered for his record-setting fraud,” said U.S. Attorney Fishman. “Katz was so focused on illegal profits that he directed unlicensed and unqualified providers to treat his patients, ordered unnecessary tests and cavalierly ordered treatments that could have caused patient harm. Ripping off the government and insurance companies is bad enough; risking patient health in the bargain is inexcusable.”

“Health care fraud is not a victimless crime. It is a plague on American society and could put the health of people who need medical care at risk, said FBI Special Agent in Charge Aaron T. Ford. “The FBI, together with its law enforcement and regulatory agency partners, will vigorously investigate these crimes and hold those responsible accountable.”

“I am proud to be part of the federal team that brought Dr. Katz to justice after a complicated investigation,” said Tom O’Donnell, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s New York Regional Office. Dr. Katz had very little regard for his patients and the Medicare program, as evidenced by his blatant behavior. Criminals can be assured that if they attempt to defraud Medicare and their patients, they will be brought to justice.”

According to documents filed in this case and statements made in court:

Katz was the founder, CEO, and sole equity-holder of Cardio-Med Services LLC (Cardio-Med), and Comprehensive Healthcare & Medical Services LLC (Comprehensive Healthcare). From 2004 through 2012, Cardio-Med had offices in Union City, Paterson, and West New York, N.J., and Comprehensive Healthcare had offices in Manhattan and Queens, New York. Both Cardio-Med and Comprehensive Healthcare provided cardiology, internal medicine and other medical services to individual patients. During that time period, Katz conspired to bill Medicare Part B, Medicaid, Empire BCBS, Aetna and others for unnecessary tests and unnecessary procedures based on false diagnoses, and for medical services rendered by unlicensed practitioners.

Between July 2006 and February, 2009, Katz spent more than $6 million for advertising on Spanish-language television and radio stations. The ads attracted hundreds of patients to Cardio-Med and Comprehensive Healthcare every day. Overall, Katz was able to bill Medicare and Medicaid more than $70 million for his services from 2005 through 2012.

Over the course of the conspiracy, Katz ordered and performed essentially the same battery of diagnostic tests for nearly all the patients he treated, regardless of their symptoms. Katz also instructed his non-physician employees to order and perform diagnostic tests for patients of other doctors working at his offices, even though he had not examined those patients and the other physicians had not ordered the unnecessary tests.

Most significantly, Katz admitted that he falsified patient charts with fictitious and boilerplate symptoms and falsely diagnosed a majority of his Medicare and Medicaid patients with coronary artery disease and debilitating and inoperable angina. He also admitted to making the diagnoses to justify prescribing and administering an unnecessary treatment for those patients called enhanced external counter pulsation, or EECP. Katz even prescribed EECP treatments for some patients with contraindications for the treatment, therefore subjecting those patients to a substantial risk of serious injury or death.

From 2005 through 2012, Medicare and Medicaid paid Katz more than $15.6 million just for his EECP treatments, most of which were fraudulent.

In addition, Katz ordered conspirator Mario Roncal, 62, of Woodland Park, N.J. – who had a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico, but did not have a license to practice medicine in any of the 50 states – to treat patients, knowing he was not licensed. At Katz’s direction, Roncal held himself out to fellow employees and to patients as “Dr. Roncal,” examined new patients as well as Katz’s follow-up patients, ordered diagnostic tests, diagnosed patients with medical conditions and diseases and recommended and prescribed courses of treatment and surgery – including falsely diagnosing patients with angina and prescribing EECP treatments for those patients.

To conceal this illegal and unlicensed practice of medicine, Roncal forged Katz’s signature on paperwork associated with Roncal’s unlawful medical services, including on patient charts. During the conspiracy, Katz used his own billing numbers to bill Medicare Part B and Medicaid for the illegal services Roncal provided as though they were provided by Katz.

Roncal was indicted on March 2, 2012, for conspiracy to commit health care fraud. He entered a guilty plea on Jan. 4, 2013 and awaits sentencing.

Katz also admitted to a Social Security fraud scheme in which, from 2005 through 2012, he kept his wife on Cardio-Med’s payroll though she performed little or no work. During the course of the scheme, Katz sent false W-2 forms for calendar years 2005 through 2011 to the U.S. Social Security Administration purportedly reflecting $1,251,604 in earnings for his wife, making her eligible for an estimated $263,000 in Social Security benefits to which she was not entitled.

The health care fraud conspiracy and fraud counts with which Katz is charged carry a maximum potential penalty of 10 and five years in prison, respectively. Each count also carries a maximum $250,000 fine, or twice the gross gain or loss from the offense. At sentencing, currently scheduled before Judge Linares on July 23, 2013, Katz will also be ordered to pay restitution to victims of his offenses. Katz was granted $200,000 bail pending sentencing.

U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford; the U.S. Department of Health and Human Services, Office of Inspector General, under the direction of Special Agent in Charge O’Donnell; the U.S. Postal Inspection Service, under the direction of Acting Inspector in Charge Maria Kelokates; the Social Security Administration, Office of the Inspector General, under the direction of Special Agent in Charge Edward J. Ryan; IRS-Criminal Investigation, under the direction of Acting Special Agent in Charge Shantelle P. Kitchen; and criminal and civil investigators with the U.S. Attorney’s Office for the investigation leading to the guilty plea.

The case is being prosecuted by Assistant U.S. Attorney Scott B. McBride of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.

Defense counsel: Blair R. Zwillman Esq., Parsippany, N.J, Joseph A. Hayden Jr., Esq.; Roseland, N.J.


Ishani Ganguli, MD, is a journalist and a second-year resident physician in internal medicine/primary care at Massachusetts General Hospital. She studied biochemistry and Spanish at Harvard College and received her medical degree at Harvard Medical School in 2011. Ishani has written about science, medicine, and health policy for publications including The Washington Post, The New York Times, ABC News, The New England Journal of Medicine, and The Scientist. As a medical student, she wrote about medical education for Short White Coat when it was part of The Globe's White Coat Notes blog. In this version of Short White Coat, she’ll explore the impact of physician training on the quality of health care and provide a trainee’s perspective on efforts to improve it. Short white coats are the traditional attire for medical students, but at Massachusetts General Hospital, students and doctors at all levels of experience wear them to symbolize their commitment to lifelong learning. Email Ishani at and read her articles and archived blog posts at
I will be reviewing her work and likely citing some of it. She's on twitter @IshaniG.

You might find this interesting (published in the NEJM, July 15th, 2010):

...Choosing primary care would be easier for students who are drawn to the field from the start if medical schools established a primary care track; provided more financial support for clinicians and students to participate in primary care mentorship, research, and clinical innovation; and recognized champions of primary care, the way medicine has recognized prominent cardiologists and transplantation surgeons. Financial and other measures to encourage students to choose primary care are helpful and may be the only way to quickly augment the primary care workforce. But ultimately, I think the real money lies in fixing the system in which we will work — making primary care better for doctors and patients and engaging future doctors in that process.

...Primary care is not a backup plan for trainees who stopped short of specialization; it is a worthwhile challenge and should reflect a deliberate choice for doctors-to-be who want to have a positive impact on both health and the health care system. It’s a challenge I look forward to undertaking when I apply for a residency in primary care this fall.
This young woman bears watching.

More to come...


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