When the Center for Medicare & Medicaid Services (CMS) reports were released April 1, the information concerning the amount of money physicians were making, it brought on the obvious reaction from the medical community, including me. In fact, I decided to use the same title for this article that I used in my letter to the editor that appeared in the Commercial Appeal, on April 14.

Physicians are all for transparency but the data which is used currently by CMS and the commercial payers is not accurately reflected.  This type of data will cause patients to make inappropriate and potentially harmful treatment decisions.  It will also result in unwarranted bias against physicians that can possibly destroy careers. 

There are other areas of healthcare where the data is also misleading. Providers know that clinical data (not just cost data) is the true measure of clinical outcomes and that they need the clinical data to improve outcomes.

“The country is moving toward greater transparency in how healthcare institutions and providers charge patients and their insurance companies. Despite the attempt at clarity, the reimbursement data can mislead. The numbers may include staff payroll and equipment costs,” said Professor Cyril Chang, director of the Methodist Le Bonheur Center for Healthcare Economics at U of M’s business college.

“A large part of the Medicare reimbursement okay expenses; medications, staff and equipment. Doctors are all for transparency, but comparing physicians’ outcomes with their peers and using quality measures are better strategies than using Medicare reimbursements,” said Keith Anderson, MD, board chairman of the Tennessee Medical Association.

“Sinai is one of a growing number of health systems across the country that has begun tackling the social, economic and environmental conditions in the communities they serve as part of their programs to reduce hospitals re-admissions and improve outcomes.” (Modern Healthcare, February 3, 2014)

“Cleveland Clinic CEO talks strategy, expansion and standardization.” (Modern Healthcare, February 3, 2014.)

Earlier this year the first Independent Mid-South Information Exchange (MSHIE) was formed as a partnership between Pediatric Independent Practice Association (PIPA), and MSHIE Systems, LLC. MSHIE Systems is a joint venture between two local Memphis companies, PCS Medical Solutions, LLC and Cornerstone Technologies, LLC.

The Mid-South Health Information Exchange represents the first project of its kind in the Mid-Mid-South: a health information exchange that will connect providers of one specialty (Pediatrics) at the individual practice level.

“Other Exchanges have focused on multispecialty, and have involved connection at the hospital level,” said Dr. William Terrell, President of the Board of Governors of PIPA. PIPA made the decision a couple of years ago to move from a ‘messenger model IPA’ to ‘clinical model IPA.’ We identified that our technology was our greatest weakness. We have developed a great working relationship and are eager to move our partnership forward.

Carmon Heilmann, president of PCS Medical Solutions and chief manager of MSHIE said, “The effort is unique. Other exchanges have connected providers to hospital data; however hospital systems contain only isolated incidents or care; when a patient receives treatment at the hospital.”

By connecting to the practice EHR systems ( approximately 80 percent of the doctors in PIPA have EHRs), the Mid-South Health Information Exchange will contain much more of the patients medical record…the information that only exists in the patient’s chart at their doctors’ office. This represents a significant amount of clinical data available to providers and others. This will be real-time data (not claims or reimbursement data) to providers in the exchange showing the latest clinical findings for the patient whether the patient was last seen by that provider or not. This capability could also be extended to providers and facilities that aren’t necessarily members of PIPA. For example, critical care facilities, hospitals and others.”

Ultimately the HIE will provide a means to analyze these large quantities of patient data for the purpose of population health management and clinical integration. Identifying the highest risk patients and developing care plans and follow up for that group. Initially the exchange will focus on immunizations records and specific disease types that are important in the pediatric arena; asthma (Memphis ranked fourth in the country), juvenile diabetes, ADHD and others. Development of care plans for these areas will aid providers in implementing cost saving plans for their highest risk, ultimately the most expensive patients, from a cost of care perspective.

Another unique aspect of this exchange is that PIPA will own a controlling interest in the local MSHIE. The exchange is physician driven. This will help keep the focus of the system on providing better care to their patients. MSHIE Systems is responsible for the development, implementation, training and maintenance of the exchange.

“Professionals in practices around the country are harnessing their own data to manage patient populations more effectively,” said Keith Wisenberg, MBA, CMPE.

The concept, discussed in a growing number of circles, has major implications for healthcare providers. During the 2013 Colorado Health Symposium sponsored by the Colorado Health Foundation, Denver, attendees were asked how comfortable they were with payers gathering and using patient data to incentivize healthy behavior. Consider the fact, the speaker said, that retail companies identify repeat customers with cell phone roaming devices, access customer time spent in front of displays and use data on their buying to customize future coupons. If supermarkets track food purchases with loyalty cards, gyms tally facility use, and credit card companies record every purchase, it might not be long before employers and payers use that data to create a picture of your health and tailor insurance premiums accordingly.

The question is not if you use it, but how to use it. (“The State of Medical Practice,” MGMA Connection, magazine.

Bill Appling, FACMPE, ACHE, is founder and president of J William Appling, LLC.  He is a national speaker, presenter and a published author.  He serves as an adjunct professor at the University of Memphis and is on the boards of Hope House and Life Blood.  For more information contact Bill at j.william.appling@outlook.com.