Practice Challenges Evident At MGMA 12

By Ken Congdon, Editor In Chief, ken.congdon@jamesonpublishing.com
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More than 5,000 physicians, practice administrators, and other physician practice leaders from all over the U.S. descended upon San Antonio earlier this week looking for answers. Answers on how to survive and thrive in a rapidly changing healthcare industry that many practices feel has forsaken them. Alamo City played host to the annual MGMA (Medical Group Management Association) conference and exhibition, where educators and technology vendors were eager to provide these practices with guidance on how to evolve.

Practice Sustainability A Primary Concern

Recent and pending reimbursement changes combined with increased IT demands have placed unprecedented pressure on physician practices from both a financial and human resource perspective. This is particularly true of smaller practices. As a result, several practices have opted to sell their practices to hospitals and health systems for financial security and support with technology system implementation.

This trend was evident at MGMA, and thought leaders in attendance offered different perspectives on this phenomenon. Some view the trend as a new reality in a healthcare system increasing its focus on care coordination. These thought leaders believe simultaneously managing the interests of both the practice and the health system is a new challenge in this environment that must be addressed effectively in order to ensure success.

“Healthcare providers faced with new payment plans or reimbursement structures need to design billing operations that support both professional and institutional operations,” said Kevin Weinstein, VP of marketing for ZirMed, a revenue cycle management technology vendor. “Setting up this operation to serve both sides of this equation is not inconsequential.”

Other thought leaders view the practice acquisition trend as a cyclical event that will spike and taper off over time. “We’ve seen an uptick in physicians seeking hospital employment several times before — most recently in the ’90s with the managed care craze,” said Jim Elliot, VP of marketing for ADP advancedmd, an EHR software provider. “Many doctors that opt for hospital employment today will find that they don’t like working for a health system, and will soon find themselves back in independent practice. Furthermore, many new physicians coming out of med school will find there won’t be enough hospital jobs to go around and will have no choice but to practice independently.”

EHR Adoption Still Shaky Among Physicians

Another evident trend at MGMA 12 was that while government incentive programs have definitely increased EHR implementations among practices, adoption and use of this technology by physicians is still hit and miss. Several theories were offered up to explain this occurrence — the most predominant of which was the claim that, quite simply, the wrong type of EHR is being applied to many practice settings.

“Many hospital-affiliated practices are required to use the ambulatory component from one of the large hospital EHR systems,” said Elliot. “These systems weren’t built for the small practice.”

“We expect to see a 50% EHR replacement rate among physician practices over the next 3 years,” said Greg Vap, senior VP of sales for Pulse, an EHR software vendor. “The primary reasons these systems will need to be replaced include inadequate implementation, limited functionality, poor workflow, an inability to meet Meaningful Use requirements, industry consolidation, and a lack of ongoing product support.”     

According to others, the way that most EHRs are designed is the reason why many physicians aren’t inclined to use the technology. “Most EHRs are template-based, and most doctors don’t like using templates,” said Dr. Jay Anders, CMIO of MED3000, an EHR provider recently acquired by McKesson. “Doctors don’t like to be locked into a certain way of doing things.”

Regardless of the structure of the EHR, there was one particular delivery mechanism that was predominantly promoted at MGMA 12 — the cloud. While not unanimous, most EHR vendors did tout the benefits of a cloud-based EHR to physician practices. These benefits include little to no upfront capital cost, ease and speed of implementation, no equipment to maintain, and secure anytime, anywhere access to patient data.

Mobile Data Access In High Demand

Cumbersome data entry requirements were yet another reason that attendees at MGMA 12 cited as a key reason why physicians are slow to adopt EHRs. “Doctor’s shouldn’t be spending 30% of their time being data entry clerks,” said Steve ZoBell, VP of product development and CTO for ADP advancedmd.

In response, many EHR vendors showcased iPad apps for their products at MGMA. In most instances, these apps aren’t meant to replicate the complete EHR on the iPad interface, but rather focus on core clinical requirements, reducing the data entry burden on the physician while untethering them from a desktop.

“Studies show that 62% of U.S. doctors currently use iPads on the job, and the vast majority are expected to use iPads or a similar tablet device by 2014,” said Matthew Hawkins, CEO of Vitera Healthcare Solutions, an EHR software provider. “It’s clear that physicians don’t have an aversion to using this technology. Perhaps good mobile apps for EHR systems can help promote physician use of EHRs overall.”

Doctors Need Big Data

A final key message delivered at MGMA 12 was the need for physician practices to start, not only leveraging, but embracing their data. Success in the new era of healthcare will largely be dependent upon a provider’s ability to share data, identify patterns and trends, and measure performance. Business intelligence and analytics tools will be instrumental in helping practices accomplish this objective.

“Physicians practices have been historically bad at documentation and leveraging their own data,” said John Stanton, VP of consulting, for RemitData, a comparative analytics solution provider. “This has largely been due to paper-intensive processes and workflows. Today’s practice needs transparency of data. They need to see where their money is coming from and be able to identify trends in code usage. They need to be able to measure their performance against their peers or industry benchmarks. This will not only impact how they are paid, but will truly enhance the care they deliver their patients.”