From the Consultant’s Corner 5/17/13

Vendor Selection Strategy
By Brad Boyd

Many healthcare organizations are evaluating the potential benefits and tradeoffs associated with replacing their legacy application vendors with a core vendor to meet their enterprise-wide patient access, clinical, and revenue cycle requirements. Core vendor solutions promise a variety of benefits, including streamlined workflow efficiencies, business intelligence enhancements, reduced operating costs, and tools to help a healthcare provider meet the various changes facing our industry (ex. bundled payments and value-based contracting).

Making an uninformed decision can have far-reaching consequences in terms of costs, patient care, and revenue cycle performance, so it’s important to approach this evaluation process in a holistic manner.

The CIO of an integrated delivery network recently asked me what I thought were the five most important things to keep in mind when evaluating core vendor solutions. The following contains some of the details of our conversation:

1. Know yourself first. It’s critical to have a full appreciation of not only your current business and clinical needs, but most importantly, the future state requirements of your organization. A comprehensive discovery process should engage C-suite leadership, physicians, patient access executives, revenue cycle management, practice managers, and department administrators.
2. Perform a total cost of ownership analysis. Not all vendors offer similar licensing and support models, and there is great variance in vendors’ implementation methodologies and staffing models, as well as post-live support requirements. As a result, an organization must calculate the costs of acquiring, implementing, and supporting each vendor. For example, a system may be expensive to buy and implement, but the costs of maintaining the system over time could be relatively low. Another system may be less expensive upfront, but the costs of long-term maintenance could be higher. To get a true appreciation of the financial implications of a potential choice, spend time calculating the total cost of ownership over 5-10 years—considering the costs to acquire, implement and maintain the technology.
3. Understand the vendor marketplace. Consolidation is the name of the game in this industry and companies are constantly being acquired and sometimes dissolved. Know where a potential vendor sits in the marketplace and how stable that position is. The last thing you want is to pick a vendor only to have the company acquired, forcing you to convert to another system because the acquiring company will no longer support the initial vendor’s product.
4. Have a conversation with the vendor without the sales people. Although the sales staff serves a purpose in explaining the product and its benefits, I find it valuable to talk with a vendor’s executives without the sales people present. During this time, ask the executives where they think the healthcare industry is going and what the vendor is doing to navigate those changes. I’ve found that this type of strategic discussion can reveal a vendor’s research and development priorities and give a sense of how the organization is preparing for the future.
5. Look at the culture. Basically you want to know whether a vendor is going to play nice in the sandbox. If the vendor is committed to implementing its product in its own way and is not willing to customize the process for your organization, that’s something to know upfront. While I think a detailed plan for implementation is valuable, the vendor should be willing to compromise in certain areas to ensure your organization’s unique needs are met.

As with any big decision, it’s important to garner multiple perspectives. I recommend putting a team together that represents all potential users of the system. In my opinion, an organization should also bring in a consultant who can offer an unbiased perspective on different vendors, cut through the sales speak, and get to the real value and help your organization fully understand the ramifications of your choice.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

News 5/16/13

INTEGRIS Health (OK) will deploy athenaCollector, athenaCommunicator, and athenaClarity for its 300 physicians.

PeaceHealth Medical Group (OR) begins its Epic go-live at its Florence clinics. 

The AMA board of trustees issues a report that looks at the how patient-physician communication is affected by the use of computers in the exam room. The study finds that a physician’s attitude toward the computer has the biggest impact on a patient’s perception of exam room computing: “The more positive they perceived their doctors’ attitudes toward the computer to be, the more likely respondents were to indicate a preference for computer use.” The board recommends that the “AMA encourage physicians to incorporate questions regarding use of computers and EHRs in patient-satisfaction surveys to provide feedback on how their own patients experience the use of computers in the examination room.”

NextGen Healthcare will integrate PDR Network’s drug information technology with the NextGen Ambulatory EHR platform.

NCQA releases the names of over 100 NCQA-Certified Content Experts on PCMHs who have demonstrated in-depth knowledge of the requirements for PCMH recognition and are interested in providing expertise to practices seeking NCQA PCMH evaluation.

McKesson expands its McKesson Gives Back Program nationwide and will provide up to 100 selected physicians with the McKesson Practice Choice EHR/PM program.

Kaiser Health News profiles two independent physicians who are experimenting with innovative practice techniques and business models in hopes of improving clinical outcomes and preserving healthy incomes. Thomas Bellavia, MD (NJ) has invested about $300,000 since 2011 to train staff and purchase equipment to transition to a medical home model that involves a team of doctors and nurses providing treatment.  He claims the transformation has led to higher insurance reimbursements and an increased emphasis on preventative care. Meanwhile Mark Holthouse, MD (CA) has opted for a concierge model that limits his clinic to 400 patients and offers alternative services such as acupuncture and fitness coaching. Patients pay a monthly fee of $220 for basic services in addition to what their insurance pays. Holthouse contends that patients are spending less on medication and hospital fees and feel providers are giving them time and quality care.

E-mail Inga.

News 5/14/13

Texas State University selects eClinicalWorks EHR and Patient Portal and the Health & Online Wellness PHR smartphone app for its student health service.

McKesson Specialty Health launches the oncology-specific iKnowMed Generation 2 EHR.

Emdeon announces Q1 results: revenue up 6.9 percent to $305.7 million; adjusted income down 3.1 percent to $76 million.

The number of patient visits to doctors’ offices fell 0.9 percent in 2012, which represents a lower level of decline compared to two years ago. I didn’t have access to the full report, but I am sure there is some correlation between lower utilization rates and the 30 percent jump in annual average out-of-pocket costs for commercially insured consumers under the age of 65 to $1,146.

The average annual net revenue generated last year by primary care physicians on behalf of their affiliated hospitals for referrals, admissions, procedures, and tests was $1.57 million. That compares to $1.43 million generated by specialists. Authors of the Merritt Hawkins-sponsored survey suggest that the nine percent increase in revenues generated by primary care providers since 2010 may be the result of the recent trend toward hospital employment of physicians.

Malo Clinic Center for Ambulatory Surgery (NJ) contracts with PriorityOne Group for IT implementation and integration, including hardware and EHR/PM software procurement and deployment.

Athenahealth completes its $168.5 million purchase of the Arsenal on the Charles complex in Watertown, MA, which includes 29 acres, 11 buildings, and 760,000 square feet of office space.

The AMA board of trustees issues a report that evaluates ICD-11 as an alternative to moving to ICD-10. The conclusion:

Our AMA harbors serious concerns and reservations with the significant burden of the ICD-10 mandate and will continue to convey these points to policymakers in Washington. However, given the even greater complexities and uncertainties with moving directly from ICD-9 to ICD-11, the Board of Trustees believes skipping ICD-10 and moving directly to ICD-11 is fraught with its own pitfalls and therefore, based on current information available, is not recommended.

The AMA, by the way, grew its membership ranks 3.2 percent last year to 224,503, or, about 27 percent of all actively practicing US physicians.

Proposed legislation in Texas would allow licensed healthcare providers to collect or verify patient information with a swipe of a patient’s driver’s license.

As the federal government pushes for EMR adoption, auditors and lawmakers are simultaneously worried that the enhanced billing features in EHRs may be contributing to the increased rate at which physicians bill for higher-level service codes. Between 2002 and 2010, the percentage of Level 4 or Level 5 established patient office visits increased from 25 percent to 41 percent. The HHS Office of Inspector General says the trend reflects better coding education and an increased proportion of Medicare beneficiaries with chronic conditions.

An eight-country survey of physicians finds that 93 percent of US physicians report using an EMR. E-prescribing rates were highest (65 percent) among US providers, as were rates for entering patient notes into EMRs (78 percent.) While the majority of doctors in all countries report EMR and HIE have had a positive impact on their practice, US doctors were the least likely to report that their use reduced organizational costs.

ONC looks at how RECs have helped nurse practitioners and physician assistants with EHR adoption. Some key stats:

• About 50 percent of all primary care NPs and 44 percent of primary care PAs are getting help from a REC
• 80 percent of NPs and PAs enrolled with a REC use an EHR
• REC-enrolled NPs and PAs have received more than $168 million in incentive funds from CMS.

Please join me in welcoming PerfectServe as HIStalk Practice’s newest Platinum sponsor. The company offers the PerfectServe Practice call management process, an automated after-hours call routing process designed around an individual practice’s workflow, call schedule, and contact preferences. When a call comes in from a patient or colleague, PerfectServe responds based on the rules for that moment, assembles the correct call path, and then routes the call appropriately via any specified messaging device or phone. The need for operators to read and interpret instructions for each call is eliminated, as is the potential for human error. Pricing for unlimited after-hours usage starts at $119 per month and the company offers a 30 day risk-free trial. Thanks to PerfectServe for supporting HIStalk Practice as well as HIStalk and HIStalk Connect.

E-mail Inga.

News 5/9/13

Surescripts releases its 2012 National Progress Report on e-Prescribing, which showed a 38 percent jump in e-prescribing routing from 2011. Other highlights:

• 489,000 (69 percent) of office-based physicians actively prescribed in 2012, compared to 390,000 in 2011.
• Nearly half of patient visits generated an electronically delivered medication history, up from 31 percent.
• 98 percent of chain pharmacies and 85 percent of independent pharmacies accepted e-prescriptions.
• Internists led other specialties in e-prescribing rates at 93 percent, followed by cardiologists (85 percent), family practice physicians (84 percent), and endocrinologists (84 percent).

The 75-physician Tennessee Oncology selects Navigating Cancer’s Patient Engagement Portal.

Allscripts will add 350 new jobs over the next five years in Raleigh, NC as it consolidates its US engineering centers. State officials will extend up to $5.35 million in incentives if Allscripts meets investment and hiring goals, plus maintains the 1,266 jobs currently in Raleigh. The company is expected to invest $2.8 million to expand its Raleigh facilities.

CMS creates a timeline for aligning quality measurement and reporting for multiple initiatives. CMS notes that for 2013, individual EPs can implement the PQRS-EHR Incentive Program Pilot. By 2014, CMS says the PQRS EHR reporting options will align, including CQMs, reporting criteria, and the reporting mechanism in the 2013 physician fee schedule and Stage 2 of the MU program. CMS has provided additional timelines for eligible hospitals and for group practices.

J.M. Winston Radiology Associations (PA) contracts with McKesson Revenue Management Solutions for billing and compliance services.

PerfectServe launches DocLink, a HIPAA-compliant network for texting, voice messaging, and physician-to-physician communication.

Amarillo Legacy Medical ACO (TX) selects eClinicalWorks Care Coordination Medical Record to advance its ACO objectives and coordinate care among its 100+ provider members.

A former director for Tennessee-based EHR developer MedRx Systems is indicted for stealing more than $60,000 from the company in 2011. Roger Finchum, Sr. is accused of making a cash withdrawal from the company’s checking account and using a company check card to purchase food, drink, fuel, snacks, and groceries. A quick Google search reveals that Finchum has been accused of participating in various scams in recent years.

E-mail Inga.

Readers Write: Regarding the Nightmare on EHR Street

Regarding the Nightmare on EHR Street
By Frederica Krueger

I find it ironic that the AMA is complaining about the fact that physician documentation in an EHR is "pure torment." Perhaps they believe in the “Hypocritic oath?”

The reason for this documentation torment is the need to record multiple pieces of information that the physician asked or reviewed but that don’t end up contributing to the synthesis of the clinical picture or the plan of evaluation and treatment. Cluttering up notes with such information is often made worse by the formatting afforded by the EHR. It also detracts from EHR usability and patient safety.

The irony is that the underlying cause of this nightmare is the E&M coding system used to bill for clinical services.

And, that the E&M codes are part of the CPT system that is developed and sold by … the AMA!

The E&M coding system was cumbersome and inane long before EHRs became readily available. In the past, it was just too much trouble to document everything that you actually did to meet the E&M requirements and too hard to keep track of all the arcane rules. But everyone naturally assumes that a computerized system should help remind you of these confusing requirements and facilitate recording of the irrelevant info that was already needed for billing purposes.

With EHRs, there is a much greater focus on appropriate recording and coding at the physician level. It’s not surprising that physicians attribute the documentation horrors to the EHR rather than the CPT.

If the AMA really wanted to do something about the torment of EHR documentation, it would:

1. Stop developing (and selling) the CPT manual. In other words, the AMA should put its money where its mouth is.
2. Advocate for a common sense approach to determine whether physician documentation is or isn’t "fraudulent" rather than the current Checklist Menu approach.
3. Recognize that most physicians are just trying to do right by their patients, and that they could do this much more efficiently — EHR or not — without having to deal with the E&M coding system. The crooked physicians will figure out how to scam the system anyway, so why waste time and money and frustrate the rest of us with E&M codes?

Despite the fact that I’ve gone for 30 years of medical practice without joining the AMA, I would sign up in a microsecond as a way of expressing my gratitude if the AMA eliminated (and got insurers and CMS to eliminate) all use of the E&M coding system.

While they’re at it, it would be nice to get rid of the RUC, RVUs and the RBRVS system, but that is less relevant to EHR torture per se.