4/2/21 Weekly Update

Summarizing the week that was in the business of healthcare

Apr 02, 2021

Welcome to The Donut Hole’s weekly summary. The news doesn’t stop. Lucky for you, we are here to help you take in the week that was in the business of healthcare.

Beth Israel Deaconess Medical Center joins Ascension to pilot Google's EHR search tool

Beth Israel and Google announced a pilot of Google’s Care Studio offering, a slick search and productivity solution which sits on top of a health system’s EMR (product video). Per the Care Studio website:

Care Studio leverages Google's expertise in organizing information to help clinicians find health record information faster. The tool’s Clinical Search feature enables nurses and doctors to simply type what they’re looking for and quickly find the specific information requested -- which might otherwise require significant time and effort to uncover.
Our tools give clinicians a single, centralized view that automatically brings forward a patient’s important information -- including hospital visits, outpatient events, laboratory tests, medications, and treatment and progress notes. And the intuitive interface offers unique ways to visualize health data and trends in tables, graphs and other helpful formats.

During the pilot phase, 50 inpatient doctors and nurses will assess the quality, efficacy, and safety of Care Studio and evaluate its fit within their workflows. Some of you may remember the uproar that followed the similar announcement of Google’s partnership with Ascension back in late 2019. Given the frequent reports of EMR-induced provider burnout, we are glad to see another health system proactively work with Care Studio. Hopefully the product will prove successful in freeing up more time for clinicians to focus on patient care and reduce the need for patients to repeat information from visit to visit.

Potential impact on you: As linked above, EMR-induced physician burnout is a significant problem. While EMR vendors have worked to improve their interfaces and feel, the fact is that most of them are legacy offerings that have survived due to high replacement costs (new licenses, implementation, nurse and physician training, etc.). We think tools like Care Studio provide a way to significantly improve the provider experiences without causing any of the disruption that would come from replacing the EMR itself.

Advantia Health opens flagship practice for women with a focus on hospitality and integrated care

Advantia Health, a women’s-focused integrated primary care, opened its first clinic in Washington, D.C, continuing its geographic expansion. The clinic is less interesting than Advantia’s model, which integrated obstetrics, gynecology, primary care, mental wellness, and more in each practice location. Advantia also includes a range of more-patient-friendly services, including telehealth appointments, same or next day appointments, free same-day prescription delivery, and 24/7 access to lactation consultants and pediatric nurses for pregnant and postpartum patients. This news highlights two major trends we’ve been tracking:

A renewed focus on women’s health. Maven, Progyny, Nurx, Rory by Ro, Visana, and others are all executing on women’s-focused care
As we’ve mentioned previously, population-specific primary care is a hot trend, particularly within the virtual care space. Other examples include Folx for the LBTQ community, Spora Health for people of color, and Papa and Oak Street for the elderly.

Advantia is backed by the private equity firm BlueMountain Capital.

Potential impact on you: Traditional primary care practices are likely to see patient volumes siphoned off by a range of community-specific and broader wellness focused clinics (like Forward). Those of you in primary care will need think through these trends, and perhaps you’ll be drawn to work at one of these more focused models. Health systems and specialists will also need to closely monitor referral patterns for more complex care.

Epic, Humana ramp up partnership to focus on streamlining prior authorizations

Epic and Humana continue to build on their partnership, which aims to increase data sharing and reduce administrative burdens for both the payor and providers. The latest announcement focuses on broadening electronic prior authorization. For context, prior authorization is a utilization management process used by payors to determine if they will cover a prescribed procedure, service, or medication. Simply put, it’s a way for payors to better control costs and deny coverage for treatments they deem unnecessary or inappropriate. Currently, prior authorization is a burdensome process for payors and providers, typically requiring lots of manual effort from providers to curate clinical data and fax (yes, FAX!) forms to payors. One 2019 study suggested that moving to electronic prior authorization could save almost $500M per year. We support any effort to reduce the administrative burden providers face, and see this partnership as a positive step to lower the cost of healthcare while improving care via enhanced payor-provider collaboration.

Potential impact on you: Nearly providers, especially those performing elective procedures and prescribing expensive therapeutics (i.e. biologics), are likely to face burdensome prior authorization requests at some point. Streamlining prior authorization workflows with technology is likely to make life much easier for individual providers and their practices and reduce the amount of money they need to spend on administrative support staff. Partnerships like this one should be emulated to allow providers to do what they do best - treat their patients.

Medical liability insurance premiums rising after stable decade, AMA report finds

An AMA analysis found that more than 30% of premiums reported by a survey of liability insurers increased from 2019 to 2020. This is the highest jump since 2005 and comes after premiums held steady for most of the past decade. The analysis also found large differences across geographies, primarily driven by variances in state laws. California and Texas, for instance, are two of the most provider-friendly states with strict caps on noneconomic damages for medical liability claims. Not surprisingly, the survey found that OBGYN physicians in Los Angeles County in California faced medical liability premiums near $49,804 in 2020 while OBGYNs in Miami-Dade country in Florida faced premiums of $205,380.

The article also notes the difference in physician behavior when they are immune from liability claims (which is the case for active duty military). A 2018 report from the National Bureau of Economic Research found that liability-immune physicians order fewer tests and procedures, resulting in a 5% reduction in inpatient spending. Interestingly, the study found no measurable negative effect on patient outcomes. Reforming medical liability at a national level appears to be a compelling option to lower direct and indirect healthcare costs without harming care quality.

Potential impact on you: Malpractice insurance is a huge expense for providers and particularly burdensome for independent physicians and physician groups. If any of you are looking to start your own practice, it’s important to consider how your expenses would vary across different states.

The Donut Hole