Practice Manager of the Month

Categories: Practice Manager of the Month

The HST team is about “professionals dedicated to the success of medical practices.” Each month, we recognize a practice manager who shares our passion and success in doing this, and provide you her or his advice.

Maggie Foda
Children’s Cardiovascular Medicine

Maggie Foda Practice Manager at Children’s Cardiovascular Medicine has two distinctions which make her unique among practice mangers in Atlanta. She has probably traveled the farthest to get where she is, having grown up in Alexandria, Egypt. The second distinction is that prior to becoming a practice manager she practiced medicine as a doctor in Egypt.

Maggie enjoys utilitizing the experience she has acquired both as a doctor and her years as a practice manager to get things done. Everyday she enjoys tackling problems and resolving issues with the idea of keeping the practice moving in the right direction.

Upon coming to this country in 1991 Maggie worked with a community health center in Houston, Texas in various capacities. She was the Associate Director of Patient Services before becoming the Practice Manager of the Center’s largest clinic. That community health center was a multi specialty organization practicing family practice, pediatrics, obstetrics and orthopedics.

Maggie believes that it is critically important that a successful practice manager be “hands on”. She has personally done every job in the practice which she believes is key to providing good support to her staff. Being hands on gives her a better perspective on what everyone in the practice is doing. Having done every job she knows what is involved with that particular job and how long activities in that job should take. Using that understanding allows her to be fair in assessing a staff member’s work performance. She believes that it makes the staff feel good to know that she is not above what they do but as she puts it “ she just has a different job title.” She believes it is important for a practice manager to be fair and objective in assessing her staff. She believes it is important that a practice manager keep the owners of the practice up to speed on the major issues facing the practice while not burdening them with the mountain of details which a practice manager must oversee.

The inspiration for Maggie’s medical career comes from the first doctor she worked with after coming to this country. That doctor she worked with started out as a nurse and did every job on the clinical side of the practice. That doctor led by example and she taught Maggie the importance of being hands on, a lesson Maggie has never forgotten.

When she is not at the practice Maggie loves to read. She admits to being a shopaholic and not necessarily a recovering one. She also likes going to museums and plays. She is a good cook, a talent she doesn’t mind practicing when she is not worn out by a long day at the practice.

Maggie has two sons both of whom live in the US. One of her sons is an engineer with Dell Computer. The other son is looking for that perfect job having earned a degree in history. His area of study was a particularly interesting period in Egypt’s long history.

The Managing Physician for the practice Dr. Eduardo Montaña described Maggie’s importance to the practice by saying ”I couldn’t run a medical practice without her.” He went on to say that Maggie is the “eyes and ears of our practice” and the ”soul of the practice.”

Hearing Dr. Montana’s description of Maggie Foda makes it easy to see that she is a very successful practice manager. Congratulations Maggie for the work you do and for your selection as Healthcare Services Team’s Practice Manager of the Month.

Friendly Staff Killing Revenue

Categories: Articles

A physician called us last week for advice. It was urgent. His concern was about a slump in new patient appointments. After talking things through, it turns out that this large group practice was answering tough competition in the marketplace with a solid marketing plan. (A good thing.) In fact, the phone was ringing. (Also good.)

He explained that they were getting additional inbound inquiry calls, but not booking many additional appointments. (Oops!) Calls, but not appointments? The “wound” was obvious.

This practice was bleeding away new business at the front desk. The front line was blowing sales opportunities just by answering the phone. And with a typical case size of $3,000-$4,500, it was a huge problem for this practice.

Unfortunately, there’s more to this tale. While the diagnosis was easily understood, our prescription to stop the bleeding met with resistance at first.

“Training for the front desk?” was their reaction. “These are nice people, they’re not rude on the phone.” In fact, the people who answer the phone were pleasant enough. They simply had no training or experience in handling inbound calls. Along with being pleasant, it takes a little sales savvy, an understanding of the caller’s perspective and a few useful tools to convert an inquiry into a first visit appointment.

Their root objection turned out to be the cost of training for the front desk staff. After all, “How hard can it be to pick up the phone?” Compared to the loss of business (roughly $3k-$4500 per case), the math was easy and the training solution was truly worthwhile. Proper training is really a cost-effective business investment. In this case, as with most, it not only saves the new patient opportunity from being lost on the phone, it protects the invested advertising budget and delivers a better Return-on-Investment.

If any of this sounds familiar to you, we should talk. It’s alarming, but 90 percent of practices and healthcare organizations lose money when they answer the phone, particularly when it comes to advertising generated inquiries.

Connect with Zac to see if your friendly team… are too friendly and killing revenue. 

Zac Wright
Difference Maker
(Z) 470.255.2454
(O) 888.296.9545
(F) 866.356.0279
Schedule time:

Why Millennials Resist Any Kind of Insurance

Categories: Articles

Young adults are the most underinsured generation of our time, which makes sense—up to a point.

Millennials are the most underinsured generation alive today—which makes a certain amount of sense. They have relatively few assets or dependents to protect. Still, the gaps in coverage are striking and offer further evidence that this generation has been unusually slow to launch.

Roughly one in four adults aged 18 to 29 do not have health insurance, twice the rate of all other adults, according to a survey from, a financial website. (Other surveys have found lower uninsured rates, but this age group is still the most likely to go without.) Millennials are also far less likely to have auto, life, homeowners, renters, and disability coverage.

Young adults have always been slow to buy insurance. They often feel invincible when it comes to potential health or financial setbacks. But something additional appears to be at work here. This generation has famously overprotective parents who awarded them trophies just for showing up. Millennials may view moving back home or calling Mom and Dad for a bailout as their personal no-cost, all-purpose insurance plan.

Millions of young adults routinely boomerang home after college or get other family financial support. The trend is so broad that psychologists have given this new life phase a name: emerging adulthood, a period that lasts to age 28 or 30. MONEY explores this trend, and its costs, in the September issue reaching homes this week. Remarkably, the parents of boomerang kids don’t seem to mind providing the extended support.

A quarter of parents supporting an adult child say they have taken on additional debt; 13% have delayed a life event, such as taking a dream vacation; and 7% have delayed retirement, the National Endowment for Financial Education found. Yet 80% of such parents in a Bank of America Merrill Lynch survey say helping is “the right thing to do,” and 60% are willing to work longer, 40% to go back to work, and 36% to live with less if that’s what it takes to help their adult kids.

“Millennials have had very supportive parents throughout their life,” says Laura Adams, senior insurance analyst at “When you don’t have a fear of the unknown, a fear of life’s what-ifs, you are not likely to think about insurance.”

Yet young people overlook certain types of insurance at their peril—even though these policies may be relatively inexpensive. Most striking is how many skip health insurance, even though the Affordable Care Act mandates coverage and allows children up to age 26 to remain on a parent’s plan. Millions more young people now have health coverage as a result, recent studies have found, and their uninsured rate has dropped. But, still, as many as one in four still go without.

This may be classic pushback against a law young adults see as unfair. They understand that their insurance premiums subsidize the health benefits of older Americans who are far more likely to need care. Yet if Mom and Dad won’t pick up the bill, a visit to the ER can cost $1,000 or more for even a simple ailment. Things get much more expensive for broken bones and other treatments that even the young may need. Among other findings:

  • 64% of millennials have auto insurance, compared to 84% of older generations. Many millennials may have decided to skip car ownership. But if you rent a car or borrow one from your roommate, you have liability. It probably pays to have your own policy, which might cost $30 a month.
  • 10% of millennials have homeowners insurance, compared to more than half of those aged 30 to 49 and 75% of those 65 and older. Fewer millennials own a house, for sure. But this generation isn’t buying renters insurance either: only 12% have it. Renters insurance is cheap: $10 to $15 a month, and it comes in handy not only when someone steals your bike from the storage area but also if Fido bites a neighbor.
  • 13% of millennials have disability insurance, compared with 37% of those 30 to 49. This kind of coverage costs around $30 a month and may seem unnecessary. Yet one in three working adults will miss at least three months of work at least once in their life due to illness, Adams says, adding, “Anyone can throw out their back.”
  • 36% of millennials have life insurance, compared with 60% of those 30 to 49. Again, this coverage is relatively cheap: around $20 a month for $500,000 of term life. If you have no dependents you might skip it. But if you have debt that Mom and Dad co-signed, you should have enough coverage to retire the debt. It’s only fair, given your parents’ years of extended financial support.

Provided by Joshua C. Harper, CFP®, CLU®, of WealthMD (877-Our-MDPlan or

Earning Gold Stars for Local Google Reviews Raises Your Search Ranking

Categories: Articles

Remember those gold stars you earned as a kid? They can still play an important part in your business’s life. But instead of putting gold stars up on your refrigerator, you put them up on your website for getting highly rated Google reviews that can raise your local search ranking on Google and other search engines.

Phil Rozek, a Massachusetts-based blogger and consultant, writes: “’Google reviews’ — which customers write through their Google Plus pages — are even more important than reviews written on other sites, like Yelp and CitySearch. Having Google reviews tends to generate more clicks from potential customers. Those goldstars catch your eye. Also, the reviews your customers write are automatically shared with their friends (the people in their Google Plus ‘Circles’). Not only can this result in extra visibility for you in ‘social media,’ but some of your customers’ friends may live nearby — which means they’re your potential customers as well.”

While Google is king of the search hill, every review site is important. At NicheLabs, we have a letter that our clients with local search programs can invite their customers to submit a review. Once you get to an initial level of reviews, gold stars appear with Google searches improving both search rankings and motivate action. The letter, which includes clickable icons for Google, Yelp, YP (Yellow Pages), Facebook and LinkedIn, has instructions for providing reviews at each site.

Our goal is to make it as easy as possible for you to get a good customer review and gold stars. Valid reviews must be written by customers in their own words, and you can’t pay for them with money, goods or services. But you can encourage them.

Rozek says giving clear instructions is the first step for getting Google reviews that warrant 4 or 5 gold stars. “No frustration or guesswork for them—or you,” he writes. He lists several conditions for review which help keep the review process honest.

  • Customers must have a Google+ account to write a review and must use their real names. This prevents anonymous reviews, which can be open to question or fraud.
  • Customers need to post the reviews themselves, through their Google+ accounts
  • Google has “filters” designed to prevent spammy or shill reviews from being posted.
  • A few of the factors that matter to the “review filter” seem to be:
    • Whether customers try to post reviews at an unnatural pace
    • How many reviews a given person has written previously,
    • The wording of the review
    • The user’s location (IP address)

We find these conditions to be consistent with Google’s rules for SEO.

Rozek’s post lists the following best practices for getting Google reviews and other reviews – that can lead to gold stars and better search ranking:

  • Ask everyone for a review, not just your diehard, happiest customers.
  • Don’t insist that people write you a review on Google+ Local, to the exclusion of other sites.
  • Ask for honest feedback and don’t ask for a specific rating.
  • Don’t ask a bunch of customers at once to post reviews.
  • Expect a few lukewarm reviews or stinkers.
  • Don’t incentivize. Not only is it against the rules, but makes you look as though you’re desperate.
  • Don’t get greedy and insist that any one customer review you on more than one site.
  • Don’t delegate the requesting of the reviews to someone out-of-house.
  • Respond to reviews – positive as well as negative.
  • Don’t stop asking for reviews – ever.

Requesting Google reviews and reviews on other sites carry the risk you’ll get a bad one, including a bad review that may not be true. Not that you want such a review, the public does accept and expect these. Nobody’s perfect; some customers are ‘sensitive or unreasonable.’ 4 gold stars or 4.5 gold stars is about as good as 5 gold stars Actually, this is a great opportunity to show you care and listen. Use these opportunities to reply publicly that you want to fix this and how to contact you. A few days later, post an update, including if the customer did not attempt to contact you.

Getting Google reviews may seem like a daunting task, but a good business can get lots of gold stars and good search rankings once you have your process in place. That’s where NicheLabs comes in. We are a full-service agency for businesses that don’t have a CMO or VP of Marketing or that don’t have the people or time to develop websites, manage SEO and digital/ direct marketing campaigns.

We can help you set up a review process and provide you with the materials you need to make it easy for your customers to give you good Google reviews and reviews on other sites – or we can contact the customers on your behalf and save you time and effort. We can help you make it part of your digital marketing program, and as part of your marketing team, we can create the channels for pushing out your strategic content and work with you to get the information out to your targeted market.

For more tips and insights about attracting more business through organic searches, connect with us on Facebook, LinkedIn or Twitter or subscribe to our monthly newsletter to read summaries of our weekly posts.

Get the gold stars and search ranking you’ve worked so hard to earn. And while we’re at it, we’d love to talk about your other outsourcing needs and lend a hand there, too.. To speak with our team, please Email us at, call 888.978.9254, or if you are mobile, visit us on your smartphone.

What Compliance Features Should I Look For When Buying A Call Recording Solution

Categories: Articles

When organizations invest in call recording and quality management systems, it is important that they understand the impact this technology has on their current compliance processes. Most companies are required to be compliant with government or industry regulations and likely have processes in place to protect sensitive data captured in desktop applications. Sensitive data includes credit card information, patient health information and other personally identifiable information. Recording conversations where this data is being captured creates a new multimedia file that also needs to be protected. These multimedia files contain both audio (call recording) and video (screen recording) representations of the sensitive data. It is important that your recording solution has the tools to protect the information in these audio and video files, and maintain compliance.

The following elements need to be included in the recording and quality management system:

Secure Sockets Layer (SSL) – SSL is a cryptographic protocol used with web-based applications. The ability to use SSL to communicate with the recording application will further enhance a solution’s ability to protect the multimedia data.

Access Control Lists – Access Control Lists are used to establish individual and group rights to the application, features and data in the Call Recording system. The multiple permission layers typically leverage a unique user ID and strong password issued by directory service, such as Microsoft Active Directory.

Scrubbing – Scrubbing is the act of permanently removing information from an audio or video file. Scrubbing tools are an important part of protecting the organization from having to retain and maintain sensitive information.

Pausing – Pausing is very similar to Scrubbing. However, instead of removing the sensitive audio or video segments from the recording, the recording is simply paused during the part of the call where protected information is shared and then resumes the recording when notified.

Encryption – Encryption is another method for protecting recorded data. With full or partial encryption the privileged content is encoded (256-bit, AES) so that only users with the passcode can view and listen to the recorded interaction.

Audit Logs – Audit logs are required by PCI, HIPAA and other regulatory organizations. Audit Logs capture all administrative and user activity within the system including who accessed a file and what actions were taken.

Recording Archival – Retention policies of the recordings may vary in different businesses and industries and these are often changed over time. An optimum solution allows for multiple recording and retention programs. For instance, an agent quality management program may only require a recording be kept for 1 year, while laws requiring retention of “verbal consents” or Telephonic Signatures may need to be kept for up to 7 years.

Provided by Paul Mancini, Clear Choice Telephones, Inc. (678-387-3200/Press 1, or

Practice Manager of the Month

Categories: Practice Manager of the Month

The HST team is about “professionals dedicated to the success of medical practices.” Each month, we recognize a practice manager who shares our passion and success in doing this, and provide you her or his advice.

Denise Kushnar
Practice Manager
Northwest Georgia Dermatology & Skin Cancer Specialists

November Practice Manager of the Month

Congratulations to Denise Kushnar, Practice Manager of Northwest Georgia Dermatology & Skin Cancer Specialists, who was selected as Practice Manager of the Month because of successes working with her provider, staff and partners.

In reflecting on her success, Denise advises, “Multi-tasking, prioritizing and delegating ensure accomplishment! There is nothing worse than a manager who just cannot ‘get things done!’ Though daily demands are ever-increasing, it is a manager’s role to lead by example and perform their duties – and then some. I never ask one of my staff to do something that I would not do myself. This sets a positive stage for overall accomplishment, completion and a ‘can do environment.'”

“In order to be a successful practice manager doing this, one must not lose sight of the minutest details that ensure a positive patient experience, the demands of the physician are met, and your staff is equipped to perform their daily duties.”

Denise gained this perspective because she has always been fortunate to have very positive female role models personally and professionally. “I can remember my very first marketing manager telling me, ‘Manage as you would like to be managed,’” Denise recalls. “To this day I have always tried to do so. Management can be very gratifying as well as extremely challenging. It is important to support, reinforce and recognize those around you. At the end of the day, you are only as good as those you manage.”

Dr. John Kayal, owner and solo practitioner of Northwest Georgia Dermatology & Skin Cancer Specialists said, “I appreciate Denise’s enthusiasm, professionalism, ability to multi-task and to generally get things done!”

“I enjoy the constant challenges and multiple roles I perform within the practice,” added Denise. “I especially enjoy working with Dr. Kayal. He is a preceptor, visionary and a supervisor who commands and demands excellence. Every day can be a growing experience!”

Prior to being a Practice Manager for Northwest Georgia Dermatology & Skin Cancer Specialists, Denise was a Practice Manager for a smaller, primary care practice, having a diverse background in sales and marketing to include hospitality management and consumer products.

Her schedule can be very hectic, nonetheless, Denise does enjoy reading and working out at Crossfit Kennesaw.

Practice Manager of the Month

Categories: Practice Manager of the Month

The HST team is about “professionals dedicated to the success of medical practices.” Each month, we recognize a practice manager who shares our passion and success in doing this, and provide you her or his advice.

Spring E. Embry
Practice Administrator

October Practice Manager of the Month

Congratulations to Spring Embry for being recognized by her colleagues as HST’s Practice Manager of the Month.

Spring, who has been in practice management for 20 years in the Atlanta area is the type of person you want to work with or work for. “Always be open to change” she advises, “and listen to your staff as well as your peers for those valuable nuggets of information that trickle in each day.” Several people at HST have commented on Spring’s willingness to listen to ideas, then deciding what is right in the practice.

Dr. Daniel McDevitt says, “Spring has combined years of experience in managing medical practices with her engaging personality to propel our team to ever higher levels of achievement.
“Change can be difficult. Spring has made change easy for our practice by her leadership style which allows her to help others overcome impediments to growth. This keeps our practice focused on moving forward.
“Managing a medical practice is never easy. The complexity can be overwhelming. Spring brings a lifelong dedication to learning and growing to the table. She can handle HR issues, billing issues, and patient concerns (to name just a few things) without skipping a beat! She truly is a joy to be around.”

Spring added, “Those who work in the trenches each and every day can provide you with so much information. It is then left up to you on how you disseminate that information for your practice’s good.”

Spring received advice from many over the years. “The most valuable and useful advice I have received over the years is to not take yourself too seriously,” she recommends. “Observe, evaluate and react to the information in front of you. Always remember to not only manage, but lead!”

“I enjoy the daily interactions between patients, physicians and staff. The satisfaction of knowing I’m making a difference by helping create an atmosphere of excellence has been humbling. I have only been with Peachtree Vascular a little over a year and I feel privilege to be part of a legacy of this magnitude.”

Prior to joining PVS, Spring worked in the medical management field for over 19 years in various capacities including Operations Manager, Practice Manager and Practice Administrator. Working in practices for Infectious Disease, Gastroenterology and Psychology over the years, her background in Finance/Accounting enabled her to be strong in analyzing the bottom line and identifying new profitable cost centers. Prior to her healthcare career, she worked in the manufacturing industry as an Accounting/Scheduling Manager with Owens-Illinois in Birmingham, Alabama.

For the times Spring is not at PVS, she and her husband spend a tremendous amount of time entertaining her two wonderful grandchildren, something she “enjoys immensely!” Spring also loves to travel, making every effort to visit all 50 states to enjoy the scenery. Once she has seen all 50 states, she’ll be ready to venture internationally.

Congratulations, Spring!

Need More Time to Work ON Your Business (instead of IN it)? Advisors Say: Outsource Marketing and Marketing Communications

Categories: Articles

Are you wearing so many hats at your business that you can’t walk through the door? We’ve written before – about how many entrepreneurs never develop their businesses to their maximum capacity because, as described in the E-Myth, they spend so much time doing their business’ operations and delivery.

Small-business coach Melinda Emerson revisited the subject of outsourcing business activities in a Huffington Post blog.

“When you can get assistance with tasks you are probably not skilled at anyway, you will have more time for higher level activities like business development and project management,” she writes. “Great leaders know it is more productive to outsource work that is not revenue generating but essential to business operations. Since time is such a prized commodity when running a small business, it is smart to leverage the talents of others rather than trying to do it all by yourself.”

Amen. Two of the activities she strongly urged to outsource, along with payroll, are marketing and marketing communications. She writes:

“Subcontract Your Marketing Efforts: Marketing is the fuel of a small business. Your marketing efforts tie directly to your sales results. So if you are too busy working in the business you already have to focus on closing the next sale, you need some help. Outsource your marketing efforts to a consultant or public relations specialist for your small business. Some marketing people will help you develop downloadable content for your website, conduct email marketing campaigns. Some will focus on reaching out to LinkedIn contacts; they can handle direct inquiries or pitch you for speaking opportunities. They can also develop media pitches and monitor HARO for media opportunities.”

“Subcontract Your Social Media Marketing: There are plenty of solopreneur marketing consultants and social media marketing agencies that can handle developing your social media strategy, content development and social promotion for your company. When you perform these tasks in-house, you often fail to retain the consistency of doing them. I am pretty sure, if you hire the right person or firm, and give them a specific niche focus and strong message about your product or service, your marketing efforts will flourish over time. Just remember that social media is a long-term strategy, so be prepared to invest 12-24 months to achieve your goals.”

Melinda also recommends outsourcing payroll, bookkeeping and administrative support. Niche Labs can help you with all of that through our referral network of trusted partners As a small business, we depend on outsourcing to help our own efficiency, and we know many people who provide a range of services that help small businesses and entrepreneurs get the most out of every precious minute they spend working on their business.

As a full-service agency for businesses that don’t have a CMO or VP of Marketing or that don’t have the people or time to develop websites, manage SEO and digital/ direct marketing campaigns, we can take on your marketing and marketing communications. As part of your marketing team, we can create the channels for pushing out your content and work with you to get the information out to your targeted market.

For more tips and insights about attracting more business through organic searches, connect with us on Facebook, LinkedIn or Twitter or subscribe to our monthly newsletter to read summaries of our weekly posts.

Let’s review your marketing and marketing communications strategies or develop them. And while we’re at it, we’d love to talk about your other outsourcing needs and lend a hand there, too.. To speak with our team, please Email us at, call 888.978.9254, or if you are mobile, visit us on your smartphone.

3 Big Differences Between a Financial Planner and an Investment Advisor

Categories: Articles

It’s no secret. There is a massive shift happening in the financial advisement industry. There are so many great opportunities opening up for young investors with smaller portfolios to have access to the same investment advisors and funds that millionaires have access to. Companies such as Betterment, Wealthfront, and FutureAdvisor are disrupting the investment advisor industry by offering low fees. Many people have been asking our financial planners here at HIGHLAND Financial Advisors, why are these investment advisor’s fees so low? Our answer is simple. They are an investment advisor, not a financial planner. Here are the differences:

1. Investment Advisors Only Give Advice on Investments

Sounds obvious right? You would be surprised at how many people believe investment advisors also provide comprehensive financial planning advice. Some investment advisors claim they do so without going into depth about the type of advice they provide. They provide their services for such a low cost because they only give investment advice.

2. Investments Are Only About 20 Percent or Less of What Financial Planners do

Well, maybe only for the good financial planners. A CERTIFIED FINANCIAL PLANNER™ (CFP®) adheres to seven different subject areas that make up the financial planning process. They include:

  • Financial statement preparation and analysis (including cash flow analysis/planning and budgeting)
  • Insurance planning and risk management
  • Employee benefits planning
  • Investment planning
  • Tax planning
  • Retirement planning
  • Estate planning

3. Financial Planners Customize

Investment advisors will ask you some questions to determine your risk tolerance and place you in a portfolio that is identical or almost identical to other portfolios they have already provided to their other clients. Financial planners with a fiduciary obligation will do something similar for investments, but they will also completely customize your financial plan based on your unique life goals. Whatever your picture of the future looks like, your planner will give you specific, personalized advice that will help you get to your goals in the most objective way possible.

It’s a great time to be an investor for individuals with small or large portfolios. With more and more companies entering the industry the choices are getting a lot better. The gap between an investment advisor and financial planner is getting wider. We suggest analyzing your own financial life and deciding whether you need simple investment advice or a more comprehensive plan to reach your life goals. Which will you choose?

By James C. Gibson, Lead Marketing Specialist, HIGHLAND Financial Advisors, LLC, Huffington Post, 08/29/2014.
Provided by Joshua C. Harper, CFP®, CLU®, of WealthMD (877-Our-MDPlan or

“Interoperability” of Electronic Health Data Is a Unicorn

Categories: Articles

Having spent $26 billion of taxpayers’ money since 2009 inducing hospitals and physicians to install electronic health records (EHRs), many champions of the effort are dismayed that the EHRs are not interoperable. That is, they cannot talk to each other — which was the whole point of subsidizing the effort.

All this money has achieved a process goal: There has been a significant uptake in EHR adoption. According to a recent review, the proportion of physicians who have at least a basic EHR has increased from under 22 percent to 48 percent. Doctors were motivated by the bounty offered, plus the threat of having reimbursements clawed back in 2015 if they did not adopt EHRs. The proportion of hospitals with EHRs has similarly increased from 12 percent to 44 percent.

But what do these EHRs do? What they do not do is talk to each other. According to the same review, “only 10 percent of ambulatory practices and 30 percent of hospitals were found to be participating in operational health information exchange efforts.”

All those billions of taxpayer dollars are paid out to providers who attest to “meaningful use” of EHRs. However, there are three stages of meaningful use. Stage 1 was easy: Plug it in and turn it on. Stage 2 was originally supposed to be achieved by 2013, but that has been pushed back until 2016. The hang up is that Stage 2 has a high hurdle for interoperability.

According to the final rule published in September 2012, requirements include “the expectation that providers will electronically transmit patient care summaries with each other and with the patient to support transitions in care. Increasingly robust expectations for health information exchange in Stage 2 and Stage 3 would support the goal that information follows the patient.”

Despite the delay, providers are still complaining that the requirements are too demanding. According to Russell Branzell, president and CEO of the College of Healthcare Information Management Executives: “Now the very future of Meaningful Use is in question.”

So it should be: Evidence from Congressional investigations suggests that meaningful-use bounties have encouraged the adoption of EHRs that are deliberately closed to exchange with other parties. The problem is that exchanging data with competitors is fundamentally against the self-interest of the party which created the data. Nobody would expect the U.S. Department of Transportation to set up a fund to incentivize car makers to exchange data with each other, or the U.S. Department of Agriculture to set up a fund to incentivize grocery stores to exchange data with each other.

That is not to say that there would be no value to such data exchange. If Safeway were out of my favorite brand of breakfast cereal, I’d love for the clerk to tell me that Giant had plenty in stock just down the road, instead of selling me something similar. However, the amount of government funding required to overwhelm competitors’ resistance to doing this would surely not be worth it.

The same goes for health information exchange: $26 billion has not done the trick. It is unlikely that the remaining $4 billion in the pot will get the job done. The Office of the National Coordinator of Health IT has been promoting a ten-year plan for more funding — even a trust fund like the Federal Highway Trust Fund!

Congress should be very skeptical of appropriating yet more funding to hunt this unicorn.

By John R. Graham, National Center for Policy Analysis, September 3, 2014.
Provided by Carl C. Schuessler, Jr., DHP, DIA, GBDS, of, BenefitStrategies, LLC (404-941-5519 or

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