Dr. Eric Fishman, CEO, EHRtv & Ann Fishman interview Jonathan Bush, CEO of athena health.
Ann Fishman: What does 5010 mean to you guys right now?
Jonathan Bush: I mean.
Ann Fishman: I read an article and the headline was HIPAA 5010.
Jonathan Bush: It’s like taxes. I am incurring but I am not thrilled about it.
Ann Fishman: Train wreck. Is it a train wreck?
Jonathan Bush: There have been train wrecks. Yeah, we’ve identified a couple of intermediaries that have fallen apart, you know, some of the payers have had trouble with it. But you know our clients kind of have come to expect that we’ll deal with that stuff and we do.
Ann Fishman: In general though, is the market ready for that, for the transition to 5010?
Jonathan Bush: It will be worse than NPI. It’ll be worse than HIPAA. Maybe on par with those combined. I don’t think it’ll be twice as bad as either one of those but people will get through it. The nice thing about these things is you lose money if you don’t fix it.
Ann Fishman: So you’re an optimist.
Jonathan Bush: So people fix it.
Ann Fishman: That’s good.
Jonathan Bush: The lab results, you know, 48% of what a doctor orders in Athena today doesn’t turn into a result by day 60 and nobody loses any money because of that. That’s appalling. You know, as of today, Athena loses that buck. So we’re going to find those.
Ann Fishman: How about ICD-10, do you see that as a big game changer?
Jonathan Bush: Well, the game is over.
Eric Fishman: I think I saw your placard downstairs – cancelled due to functional disarray in the industry.
Jonathan Bush: I mean you know, in general it’s nice when your government doesn’t act like a middle African hunter, you know the fearless leader’s decided to go to the left. Oh we all should go to the left. The fearless leader is getting bored he wants to go to the right. Oh we all should go to the right. The fearless leader wants to do this, another day. Okay, let’s all go home, you know. It’s sort of like why does the fearless leader sit still and let the game progress. It’s the meat stuff that could have come out of anything – well I mean ICD-10. A lot of it could have happened without it. It’s just a function of staying still long enough to let the market adjust.
Ann Fishman: Right. And the market is adjusting. You know I’ve read this article – this paper today.
Jonathan Bush: Yeah.
Eric Fishman: Not already.
Ann Fishman: It is so chock full of funny things. I wanted to get your read on it. For instance…
Jonathan Bush: I just saw my funniest thing.
Ann Fishman: You might find something that I didn’t see.
Eric Fishman: And what was that?
Ann Fishman: For instance, I was shocked.
Jonathan Bush: The nuge – the word Caradigm. It’s got to be the funniest word of 2011.
Ann Fishman: Yes. That’s tomorrow, Caradigm.
Jonathan Bush: Caradigm.
Ann Fishman: That’s cute.
Jonathan Bush: It’s a paradox; it’s like two docs – the paradox.
Ann Fishman: Should we say – Microsoft and GE, well they had to come up with something clever. So look “Could a Republican president slow Health IT? So, is healthcare political? Is it that political in the U.S.?
Eric Fishman: What do you know about Republican presidents?
Jonathan Bush: Well, yeah, you got, I mean…
Ann Fishman: So is it…
Jonathan Bush: Yeah of course that’s why it’s so backwards. You have the biggest customer in healthcare, is the government and then the regulator. Remember the character Big Louie in Guys and Dolls?
Ann Fishman: No.
Jonathan Bush: And he’s losing. Big Louie is the big, huge guy and he’s got a gun. He’s the only character in Guys and Dolls with a gun, he takes off his giant jacket and there’s the whoa… and they all see that, right? And he’s losing like crazy. And Sky Master says, luck be a lady to night and he wins and he wins and he wins. And the young Louie is like, I don’t like this game. We’re going to play with my dice. And this big guy pulls out these dice and he’s like – and the Sky Master says, but there are no spots on those dice. Don’t worry. I remember where the spots are. Now let’s play dice. You know, and all of a sudden Big Louie starts to win, you know, like every single one. Whoa, it’s heaven, imagine that.
Ann Fishman: Magic dice, how do you think of that?
Jonathan Bush: Yeah so I think in general…
Ann Fishman: Yeah.
Jonathan Bush: The government is the regulator but not disinterested because they don’t have the courage to tell their constituents that they can’t afford what they promised them, right? So they have to pay for it. So they’re basically using their role as a regulator to try to beat up their – to win as a player in the market. Now I understand it and I respect it and it makes sense. I know how it came. You know I remember World War II you know, we needed to pay them for more but we didn’t want to have wage inflation so we started off – I mean, I got it, I got it, I got it, okay. But anyway, here we are, and when you have this random actor like that, entrepreneurs don’t want to enter because Big Louie could always get out the dots with no dice but dice with no dots. In general these top down initiatives where the committee decides what everyone is going to go do in a free country, don’t work. They don’t work, you know. Now sometimes the fear of it creates the scuttling, you know. You put the magnifying glass on the ants and they run around and maybe they do something. It’s not what you thought they’d do but they do something. I mean, I’m cognizant of the fact that lots and lots of health systems are talking about coordinating care and they were not before 2008. That’s interesting.
Ann Fishman: Are we going down this road? I mean, do we have too much government control over what you’re interested in?
Jonathan Bush: Oh it’s a disaster. I mean devastating, unfortunately.
Ann Fishman: You know I was reading the HIMSS digest version of the ACO Regulations.
Jonathan Bush: Yeah.
Ann Fishman: I couldn’t understand it. There was 115 pages. That was the cliff notes version.
Jonathan Bush: And who enters this game? And if you watch the behavior of the government with HIPAA, then with MU, now with ICD-10, it’s so fickle. You know I was staying at the Wynn Hotel. I saw this videotape of Steve Wynn who says I’m moving my headquarters to China because it’s a freer market.
Ann Fishman: Oh nice.
Jonathan Bush: How offensive is that? So okay I got to tell you, they haven’t changed their regulations since they opened. Here in the United States, the regulations of the companies have changed 162 times blah, blah, blah, sometimes more, sometimes less. And it’s always by surprise and I don’t understand. You know, I can’t grow a business that way, of course he seems to be doing okay. But – and Athena is doing well. I mean, I am complaining but you know, I just think that we have spent so long without a healthy market in healthcare that we don’t even know how to think about it. It’s like a foreign, abstract idea and you know, I just got to – I am sort of continually focused on, how can we get more use of that idea so that it’s not so foreign, you know. What is the transistor radio that is going to be the great, great, great, great grandfather of healthcare’s iPod or iPhone, right? What is that first move? Is it Athena? Is it – We’ve got a group called More Disruption Please of Healthcare Entrepreneurs that can use each other as supply chain partners, use us. We’ll sell their stuff. If it will include the doc’s collection for doing the right thing, we will sell it to our base for them. To get more people to have the courage to enter even as the government still fickly moves in and out, in and out, in and out, scaring the crap out of, you know, investors.
Ann Fishman: What about Meaningful Use? Is that more about better medicine or collecting data?
Jonathan Bush: Well, I think they’re related, right? I mean, what I viewed, I viewed Meaningful Use. I do view Meaningful Use as a moderately successful certainly successful for Athena as we are differentiating ourselves from the other guys. We got…
Eric Fishman: You got your dashboard.
Jonathan Bush: 83% -- there’s the number.
Eric Fishman: I want to hear the details on that.
Jonathan Bush: So okay here’s the number. 680,000 practicing docs, only 191,000 even registered for the program. Of that, 23% make it, okay?
Eric Fishman: Did the other 77% not apply or they fail?
Jonathan Bush: No – so, what is that? So 23% of 200,000 is 40,000. So 40,000 out of 600,000, about 8% of guys who could play the game, won the game. So you know…
Eric Fishman: That’s universally and…
Jonathan Bush: So 70% didn’t play, 60% didn’t play. Of those who did play, 23% won. Athena, 83% of all of our clinical clients played and won. Everybody who played won; something like 6 guys and everybody played.
Ann Fishman: How did you achieve that?
Jonathan Bush: So that’s the differentiator.
Ann Fishman: Yes it is.
Jonathan Bush: We’re a cloud-based service. You know we’re the worst cloud-based service in healthcare and we’re the only cloud-based service. There’s a lot of wannabes trying to get started and you know, oh we’re in Athena but we’re cheaper. We’re in Athena but we have a Mac or we’re in Athena, you know, there is like six guys in a room you know (Inaudible – 08:33) and VCS and you know it is fun to watch them. The colors are green, you know and I am like, it was a terrible idea to make it green. Don’t copy that part, you know. But that’s the basic gig for me is get more people to play the game and you want innovation. You need many buyers, many sellers and freedom to move about the cabin. Freedom to – if I tradeoff, if I try this instead of that, if I get the family pack in store in the basement; I save a buck, right? People love that coupon and people say; oh we’re culturally not attuned to low healthcare costs as a society. If we can keep some of that money, we’d be freaking culturally attuned like you read about but we’re not allowed to keep the money. So it’s like all right, do whatever.
Eric Fishman: There is a thousand booths in this hall of HIMSS. How many of them do you think are doing something close to the right thing?
Jonathan Bush: So you got two groups. You got the new entrants who are here with a tabletop like we were. I remember Bob Hubart was here with the - you pull that little thing up and you hook it on like a whole movie thing but it’s got like a little Athena leaf you know. There is a bunch of those guys and what they’ve got is consumer related apps that are like two generations out of their time. But good stuff. Just – I don’t quite know what the business model is. Oh the payer is going to pay for it and I am like, they are just not going to do anything even if they want to. They are too big and dumb and they’re working on their obsolescence right now. They’re not – they probably won’t break out of it or if they do, it would be like winning a lottery that you got the one business development guy who pays attention and he did a deal with you, and you know. So it’s happening. I want to be an ecosystem for those guys. I feel like those are the guys who will make a difference. And then you got, you know, the dinosaurs who are running around mating and joint venturing themselves, you know. I don’t know. I am not that. I’m this now. I’ve a new name. It was like when US Airways went out of business and they did a Hue project and they came out with a new airline magazine and they changed their name to US Air.
Ann Fishman: I want to hear about India.
Jonathan Bush: India?
Ann Fishman: What are you doing? So with not development, installations?
Jonathan Bush: Oh we have these big teams in India. Dell and IBM are two big partners that receive from us, we flash in front of them, all of the information that still comes in on paper. So we get about 30,000 pounds of EOB paper from the, you know, these troglodyte insurers that still can’t do electronic funds transfer or can’t do electronic. You know people’s Mickey Mouse Ear Checks, you know Debbie and Diana Smith co-pay $20 you know, that stuff is still part of healthcare.
Ann Fishman: Okay.
Jonathan Bush: And our clients don’t deal with it because we deal with it but we scan this paper and every night whatever got scanned that day gets data entered and then sucked backup into the system, reconciled against the AR, the errors get or the questionable ones get checked. We do have errors. I think we have about 0.02% error rate to 99.98% accuracy.
Eric Fishman:More than Ivory Soap?
Jonathan Bush: What?
Eric Fishman: Better purity than Ivory Soap?
Jonathan Bush: Oh yeah. But there is a quadrant of them that we’re learning a lot more about that are like – we have like one error for every 10 – or 6 errors every 10,000 or something like that. I don’t really know the exact number but we got a whole team that then reconciles those and you cook it down and figure out what to do next. We also get all of the – the doctors don’t get any faxes when they turn on athenaClinicals because we call the phone company and forward those faxes to our data center and then we read all their faxes and most of it is labs results – I mean some of it’s…
Eric Fishman: Do you take the data out and have a human being transfer it?
Jonathan Bush: Exactly, yeah.
Eric Fishman: How does that work?
Jonathan Bush: So there is some data, there is still object data in a fax. So there is the little – you know that weird little bar with the stuff across the top. So this is the caller ID and that stuff is objective. You can actually pull that data into a database. So if it says Benny and Jim’s home fax, you can’t do much with that but if it says Lab Core Region 6, you know and the caller ID matches the Lab Core Region 6, we can flash up that this is probably a lab result to one of the lab accessions that went to Lab Core Region 6 and now you have a very narrow subset. We also know it came into Practice number 6,221 because it’s their fax number that it went to. So now you have an even narrower subset. Now when you do your data matching where you’re looking for orders to match the results due to tie out and close the loop, nobody in healthcare closes the loop. Every doctor walks into an exam room, right, and says, so how is the Dilaudid working? All fine. Person may never – they may know what you are talking about but they’re not going to say NO to the great doctor right then. And so this is closing the loop, closing the loop. But if you’re going to close the loop for doctor, you can’t only do it for the subset of information that’s electronic, there’s not very much information that is electronic. And so that’s been a big focus of ours as a company and we’re very excited. We finally got permission to really Amp It up. This year, we have changed the pricing of Clinicals.
Eric Fishman: Is that the OIG?
Jonathan Bush: Yeah. OIG gave us permission last year. Starting last Monday, the sales force hit the field with a new pricing.
Eric Fishman: Buck a pop?
Jonathan Bush: Buck a pop. So it’s about 40% off of our old price. It’s still of a percentage of collections fee for all of the reporting, pay-for-performance rules and just the basic medical records, storage of the data and stuff like that. But then about 40% of the revenue is now a buck a pop and the receivers are allowed to pay it. Of course the receivers are dying to pay because they really like to customize the data that they get from that doctor but they don’t want to piss the doctor off because the doctor is giving them value and they’re not giving the doctor any value because that’s illegal. Now they can ask for specific data fields. We can change the message, it doesn’t interrupt the doctor but the receiver of the lab or the pharmacy or the specialist of the hospital can get exactly what they need. It still involves paper, you know. We’ve taken on pre-certs. So now you got to go and half of these insurance companies, a pre-cert transaction exists – an electronic precertification, we have not found one insurance company using it today. So you can go to their website manually and look it up so you got to – starting up an army of people to go and do pre-certs for hospitals. We now serve hospitals, just the frontend of their revenue side.
Eric Fishman: Now you rank the insurance companies?
Jonathan Bush: PayerView?
Eric Fishman: Yeah. You are ranking them on the various functionality that they’re adding in?
Jonathan Bush: Well, their performance – we call it the pain in the butt index, right. It’s how big a pain and how often do I have to call you? How often do you send stuff to me on paper? How often do I have to resubmit? But what’s neat about this change in the clinical supply chain, right, is that it’s actually part of their value – financial value. So doctors are staring to care whether their orders and results match. It means money to them, which means that they will have referral view, they will have lab view, they will have specialist view where we will start to say, look, in this market which specialists. We now have data that says when you sent cardiologist A, your patient’s chart gets there electronically. The patient is seen in 8 days – an average of 8 days, and the result comes back with a note within 3 days of the visit. If you send a cardiologist B, it’s two weeks. You get a fax two weeks after that. You know maybe you’ll start using cardiologist A.
Eric Fishman: And you include the quality of care ACO style?
Jonathan Bush: I think right now knowing that they showed up at all is a major improvement in quality of care. I am not letting us get distracted by abstract, beautiful keynote speech at HIMSS versions of quality of care, while nobody actually does anything electronically anywhere.
Eric Fishman: 25 years ago we moved to Florida. Needed a plum rope and the biggest full page ad, the single thing that they thought was most important in the biggest font is “We show up” and if you’re telling me that that’s where the physicians are…
Jonathan Bush: Yeah it is. It is. When I send a patient to this hospital, I want to know that they’ve been pre-certed; I want to know they’ve been consulted with, I want to know that they’ve been seen, I want to know that they have been discharged and I want them back, right? Who cares? At this point, nobody really is so esoteric what’s quality and what’s not. It’s known. If somebody starts to have bad outcomes or so I think, we avoid them like the plague, right? But the assumption is a 100% quality with whatever that means, who knows, right? These are the first actual objective potentially market-based measures of quality I’ve ever seen. So yeah, I think it’s quality but it’s not keynote quality. It’s actual, practical, tactical day-to-day quality.
Ann Fishman: HIMSS 2012, we’ve just been with Jonathan Bush from Athena. It’s been great. We could talk all night but we’ll have to adjourn until next time. Thank you.
Jonathan Bush: Thank you Fish people. Thank you, Fish watchers.