From the Consultant’s Corner 4/28/11

Four Key Strategies for Successful Medical Group Development

The pressure is on. With all of the focus on “integrated” care delivery — accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and the like — many medical professionals see no choice but to band together. Consolidation is happening up and down the board, from individual doctors joining forces to large hospitals buying up equally large group practices.

But the universal question is this. How do you make sure the medical group you form today won’t fall apart tomorrow?

Obviously, that’s not a simple question to answer. The best way to start is by combining some lessons from the past with a critical look at your medical group’s goals and culture.

Here are my four key strategies for successful medical group development.

1. Let organizational culture and goals dictate your alignment strategy. Each group member’s unique assets and strengths must be leveraged, not ignored. Truth be told, it’s the most important of the “key strategies.”
2. Consider using an independent management structure. It’s often the best way to bring objectivity to market evaluation and to decision-making processes.
3. Include physicians in joint, meaningful governance roles. I can’t overestimate the importance of shared management responsibility. Regardless of the ownership structure, physicians must be given some control over practice operations and a say in long-term plans. On the other hand, physicians also have to be prepared to give up some of the autonomy they might be used to as the head of their own practices.
4. Start building a relationship around IT. It’s a good starting point for all sorts of discussions because it’s the foundation for solid, evidence-based medicine.

The very first step is to make sure your strategic plan matches your unique market and your individual organizations. There is no “one-size-fits-all.” The management style used to grow the group across town, for example, might actually destroy your own growth potential. A development plan must be tailored to fit.

Of course, there are almost as many effective management models as there are medical groups. Some may prefer a joint venture without physician employment. Others may want 100% physician employment as a division within the organization.

When I help design alignment strategies, I make sure all sides understand the “win-win requirement.” That means no matter how we develop the deal, everybody has to walk away with a better ability to serve patients. That is, after all, the common denominator.

To help make sure all decisions are objective and fair to everyone, I sometimes suggest placing an independent management structure “in the middle” of a medical group. A management services organization (MSO) or similar third-party management arrangement is one way to make sure the interests of all parts of the group are well represented. But whichever management structure is chosen, one thing is clear: medical groups today must make sure physicians have a voice in governance.

Think back to the 1990s when hospitals were buying physician practices to adapt to managed care. One of the key reasons these coalitions failed was because they didn’t pay enough attention to the relationships between hospitals and community doctors. Very often, doctors that were kept out of governance roles felt at odds with their hospitals. It might seem like a minor issue, but it’s really the difference between a group that pulls together and one that pulls apart.

Fortunately, today we have information technology (IT) acting as a pretty powerful uniting factor. Deciding how to best use IT to benefit patients is a fairly universal concern, so it makes a good starting point for group discussions. In fact, clinical integration among group members typically flows from IT infrastructure, because providers understand that access to data across the continuum of care can improve their own patient outcomes. And ultimately, of course, it’s this resulting improvement in patient care that defines the successful development of any medical group.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.

News 4/28/11

eClinicalWorks joins Office Ally as a preferred vendor for the HIT Extension Center for Los Angeles (HITEC-LA).

EncounterPRO chooses Intuit Health’s patient portal to offer its 300 pediatric practice EMR customers. Intuit Health, by the way, intends to add 10-15 new jobs this year at its Cary, NC headquarters.

The New Mexico HIT-REC names six initial vendors as "appropriate and qualified" EHR partners. In return, Allscripts, athenahealth, eClinicalWorks, Greenway, NextGen and Sage agree to standard contract provisions for NM providers and discounted pricing.

CaroMont Health (NC) selects athenaCollector, athenaEHR, and athenaCommunicator for its 200 providers. I hear that CaroMont is replacing its legacy NextGen system.

The Florida House passes a bill requiring urgent care clinics owned by hospitals to post the prices for their 50 most frequently provided medical services. The bill also allows primary care providers who voluntarily post their prices to skip two years’ worth of CME requirements.

Odd: Greater Chicago Urology files a lawsuit against one of its doctors and asks a judge to evict him from the practice. The practice claims Dr. Leon Lome’s “intentional outbursts and fits of anger” have caused the office to lose patients and have created a hostile workplace. The suit states he takes medical supplies belonging to the office at large, shouts at employees in front of patients, and throw patients’ prescriptions on the floor in front of them. Furthermore, he insists on displaying a calendar with images of male genitalia in the common area. Other than that, he is a really great guy.

digiChart introduces PracticeSmart, a new integrated, single database EHR/PM solution for OB-GYN practices. The product combines the company’s original digiChart OB-GYN EMR with the digiChart’s proprietary PM platform.

Office Ally adds an automated eligibility checking service to its Web-based offerings.

EDI clearinghouse provider Availity appoints Jon Zimmerman SVP and GM of clinical solutions. He was previously SVP of solutions management at Allscripts and SVP of enterprise solutions at CareFusion.

The Center for IT Implementation Assistance for South Carolina (CITIA-SC) names SuccessEHS one of its preferred EHR vendors.

NIH launches a Web site to give providers access to evidence-based information on complementary and alternative medicine. The site includes information on safety and effectiveness of such therapies as natural products, dietary supplements, herbs, meditation, massage, and acupuncture. Patient fact sheets are also available.

Practice Fusion says it now serves over 10 million patients and 80,000 medical professionals and is adding 350 new users each day. CEO Ryan Howard says PracticeFusion is now the largest EHR community in the country, surpassing Kaiser and the VA. In case you missed it, here’s my interview with Howard from a few months back. I noticed that in the last week, readers have posted a few new comments about the interview.

OCHIN, a non-profit provider of HIT products and parent of Oregon’s HIT REC (O-HITEC), enters an agreement with Gateway EDI to provide EDI services for OCHIN/O-HITEC members.

Integrated Medical Professionals, a 100-urologist practice in New York, partners with PatientPoint to use its self-service check-in technology for data collection and reporting.

The state of New York promises AmkaiSolutions over $434,000 in tax credits and $100,000 in sales tax breaks for moving its operations from Connecticut to New York. AmakaiSolutions, which provides software solutions for surgical practices and ambulatory surgery centers, pledges to create 103 new jobs over the next five years,  including 35 this year.

Six organizations issue the 2011 edition of A Clinician’s Guide to Electronic Prescribing, which gives guidance to providers transitioning from paper to e-prescribing systems. Collaborating partners include the AMA, MGMA, AAFP, e-Health Initiative, ACP, and the Center for Improving Medication Management.

E-mail Inga.

News 4/26/11

CMS offers a Meaningful Use Attestation Calculator that allows providers and hospitals to assess if they have met all required objectives. Providers can enter details on which core and menu MU items they are using and the calculator will provide a pass/fail for each specific measure. Great way to determine if a provide could successfully demonstrate MU.

RCM provider CompONE Services appoints Kevin O’Keefe executive director of client services. He’s a former VP of radiology for Mckesson.

Rockford Health Physicians (IL) rolls out RHS MyChart, giving patients access to their medical records and the ability to communicate electronically with providers. As the name suggests, Rockford Health Physicians is implementing Epic.

New Mexico HITREC names Sage Healthcare an appropriate and qualified vendor after evaluating its Intergy EHR Meaningful Use Edition.

OB-GYN PM/EHR vendor digiChart names Phil Suiter as president and CEO. He most recently served as president and CEO of Transaction Tracking Technologies and was director of strategic projects for Vanderbilt Medical Center’s Department of Medicine. The former president and CEO, founder and Vanderbilt professor G. William Bates MD, will remain with the company as board chair.

Capario names Stephen Garcia CFO. Garcia’s background includes initial and follow-up IPOs, as well as restructuring.

Altos Solutions announces that the three-physician Lake Norman Oncology (NC) has successfully attested for MU using Altos’s OncoEMR.

Two of Massachusetts’ largest physician groups discuss merging to form an 1,100-physician organization. The fact that Atrius Health and Fallon Clinic both use Epic’s EHR, PM, and scheduling platform would presumably make for an easier transition.

Orthopaedic Surgery Associates (MI) selects SRS EHR and CareTracker PM for its 13 providers.

The AMA advises physicians to prepare for possible cash flow issues once the 5010 code set goes into effect January 1, 2012. They warn that technical glitches could delay payments, so practices should establish a line of credit and limit spending when possible.

I noticed on Greenway Medical’s website today that President and CEO Tee Green recently presented a $3,500 college scholarship to a Carrollton High School (GA) senior as part of the company’s mission to support the Boys & Girls Clubs of Metro Atlanta. Over the last year, Greenway has provided funds, on-site mentoring, and company-sponsored internships for about 200 Carroll County youth.

The Centricity Healthcare User Group (CHUG) is having its spring conference April 29-30 in San Diego. CHUG is a vendor-independent group, although GE is hosting an evening reception and numerous GE employees are scheduled to give presentations. Registration is $525 for both users and GE employees. If you are attending, send me an update from the field.

The Mid-Atlantic Association of Community Health Centers forms a strategic partnership with Phytel to support utilization of Phytel’s population health management tools by its member centers.

Home Physicians Management, a house call-based practice, receives an $11.5 million investment from Triangle Capital Corp. The house call market is predicted to grow due to aspects of last year’s health reform legislation. Analysts see Triangle’s investment as a vote of confidence for the house call model.

MD-IT EMR secures ONC-ATCB modular certification.

E-mail Inga.

DOCtalk by Dr. Gregg 4/25/11

Brilliance Makes It Look Easy

Gene Kelly. Fred Astaire. I wish those guys were leading the charge for HIS development.

No, I don’t think that EMRs need to sing in the rain or that practice management systems could benefit from dancing on the ceiling. What every HIS system to date could use, though, is the “duck on the pond” effect that these two pros had completely mastered.

You know the “duck on the pond effect”: the appearance of gliding smoothly and serenely across the pond while little webbed feet are paddling along furiously below the calm, still waters. Those who provide that effect, no matter their profession, make it look like anybody could do what they do. They make it look so easy and effortless.

Astaire and Kelly always made it look so simple. Yet, both were the ultimate in “efforting.” They were relentless in their pursuit of perfection, working themselves, and their co-stars, into blistered and bleeding toe exhaustion when trying to nail down a routine. The end result of all this blood, sweat, and (I’ve read) tears was unparalleled mastery of their craft and brilliance in their performances. Kelly’s muscular machismo and Astaire’s suave elegance were the result of tremendous under-the-water paddling.

There just simply aren’t many EMR or EMR-related systems out there that really have this Kelly-Astaire idea down. Most of them do a whole lot of stuff under the covers, sure, but their dance isn’t smooth, their “paddling” is evident. On top of their waters, it’s choppy.

On the EMR stage, this lack of behind-the-scenes work and the shoddy showmanship is manifested time after time. We have many, many EMRs which are like back-up dancers: they can do the basics, but that star finesse is just not there. If the developers don’t put in the relentless pre-show effort, the audience (the end users) will have to suffer through the performance. We’ll get through it, but it is rough and uninspiring.

Some developers do seem to have started to “get” the power of this pursuit of perfection. Instead of sending out an understudy, they have seen how much is gained by putting a truly well-trained star on stage. They’re creating tools with the simplicity of use that all end users, medical or otherwise, crave. Some of the new iPad-savvy EHRs are showing some of this refinement. So are some of the new iPad / iPhone / Android medical apps.

Here’s a perfect, specific example: Medicomp and their new Quippe tool. They certainly understand how much you can do under the covers while making it look so danged simple on top. Their experience, though, may show just how unready much of the industry yet is for such superstars. I’ve heard technorazzi say, “Oh, it’s just a bunch of XML-tagged text.” End users might not see how hard it is to make it look so easy, but once we see how smooth the surface show is, we want more. It surprises me that any EMR technico wouldn’t see how much goes on, and has gone into, making the “dance” look so smooth. Maybe they, too, don’t see the power, the feet furiously paddling, under the surface.

But, that’s just the kind of power I’m praying for in my next EMR – the kind that seems like anybody could do it, a system with those Gene and Fred work ethics, grace, and “it looks so easy”-ness. I want this super paddling below and an EMR “glide” on top.

For NHIN success, we need many more such “stars.” Despite my “I want it now” angst, I think it’s inevitable that we’ll start to see these traits begin pervade the whole of the HIT industry. I’ll even wager real money that those vendors who don’t clue in to this concept sooner will come to envy those who do.

Once these ideals are more widespread in the EMR realm, just think how far we might be. Even more, imagine once all HIS tools are empowered by those same qualities, but from Ginger Rogers. She, as you probably know, could even do it all backwards – and on gorgeous, high-heeled, Inga-esque footwear!

From the trenches…

“Some people seem to think that good dancers are born.” – Fred Astaire

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 4/20/11

CMS says it paid physicians more than $234 million in Medicare incentive bonuses for the 2009 PQRS  program and an additional $148 million in 2009 e-prescribing incentives. The PQRS bonuses averaged $1,956 per provider and $18,525 per practice, while the average e-prescribing bonus was just over $3,000 per provider and $14,051 per practice. CMS reports that participation in PQRS has grown 50% per year since it first began in 2007.

Practice Fusion hires Paul Willard as VP of marketing and Liz Meyerdirk as senior director of business development. Willard was most recently VP of marketing for Coupons.com; Meyerdirk was associate VP of corporate strategy and business development for MedeAnalytics.

Radiology & Imaging (MA) and Seacoast Radiology (NH) select McKesson’s revenue management solutions for billing and coding. I mentioned Seacoast Radiology a few months after hackers breached one of their servers. The likely culprits were said to be “rogue gamers” looking for bandwidth to play Call of Duty: Black Ops.

AMA rolls out its AMAGINE platform nationwide. The subscription-based offering ranges from $20 per month per physician for e-prescribing to $300 a month for EMR. AMAGINE includes access to over 20 HIT solutions, including Allscripts, CareTracker, QuestCare 360, and NextGen.

Beacon IPA (NY) partners with Sequel Systems to offer its members discounted pricing on SequelMed EMR and PM products.

Patients perceive that the use of EHR increases the quality of care and provides a more accurate health record. Eighty-percent of patients have a positive perception of EHRs, though only 62% of physicians feel the same way. Patients are more concerned about privacy and security (81%) than doctors (62%). Both groups agree that the biggest benefits of EHRS are real-time access to records and  the ability to share information among providers.

Allscripts opens registration for its ACE 2011 conference. This year’s big event is August 29-31 in Nashville. If I am reading their graphic correctly, Allscripts expects its ambulatory EHR clients to outnumber the Sunrise customers by about two to one.

The Missouri HIT Assistance Center selects SuccessEHS as a Group One vetted EHR vendor.

Physician offices are better at retaining RNs than hospitals or health systems, likely because of the better work environment. RNs work an average of 3.3 years at a physician offices before changing jobs, but only 3.1 years at general hospitals. Average compensation is higher in hospitals than physician practices, but offices tend to  offer more stability and better culture.

Odd: Physician’s Computer Company issues a press release chastising payers and clearinghouse partners for their “lack of readiness” to test the new 5010 transaction standards. PCC says it has validated its own readiness with its direct-to-payer connections, but is waiting on more than three dozen carriers and clearinghouse partners to get up to speed. I can’t figure out what PCC has to gain from issuing the release, other than a few ticked off partners.

American Well launches Online Care for Providers, a new service that enables physicians to offer telehealth to patients. The offering includes the ability to conduct two-way video, secure text chats, and phone calls. Encounter records  may then be then download into the provider’s EMR.

Most physicians that are considering hospital employment expect to be paid one to five percent more than they are now. Employed physicians believe doctors should be more involved in executive leadership and hospital management, including service on the board of directors. On the other hand, hospital executives aren’t ready to hand over the keys yet and say they’ll need to find funds in order to pay physicians more. Train wreck, anyone?

E-mail Inga (who is visualizing the weekend a bit early)