Magazine Article | September 29, 2013

Practices Under Pressure: 6 Ways To Cope With Rising Health IT Demands

Source: Health IT Outcomes
ken congdon

By Ken Congdon

The financial and resource requirements for health IT deployments are becoming too much for many physicians practices to bear. These 6 tips can help you successfully tackle the health IT beast.

The national health IT movement spurred by the HITECH Act is taking its toll on providers of all shapes and sizes, but physicians practices (particularly those that are independently owned and operated) have been hit especially hard. One of the biggest challenges doctors’ offices face is absorbing the significant costs associated with implementing a health IT infrastructure. Many physicians practices don’t have the revenue stream or budgets to comfortably accommodate IT expenditures, and according to the latest research by MGMA, these costs are rising exponentially. MGMA’s 2013 Cost Survey Report reveals that information technology costs climbed 27.8 percent between 2008 and 2012 (from a median of $15,211 to $19,439 annually). No drop in the bucket for a small practice.

According to Derek Kosiorek, principal of MGMA’s Health Care Consulting Group, doctors’ offices are also having a hard time adjusting to the pace at which IT initiatives are driving change in the healthcare sector. “Too much is happening too fast for many physicians practices,” he says. “Systems and technology are evolving faster than practices can put the processes in place to support them. Insufficient change management is having a negative effect on clinical workflows and leaving many physicians with a bad opinion of health IT.” The technology itself isn’t helping matters any. Data interoperability between EHR systems still isn’t a reality, which negates one of the most significant benefits promised by the technology investment — the ability to move patient information quickly and efficiently between practices or within an office. This has become a huge complaint for independently practicing physicians. They feel duped, because many have yet to realize any true return on their technology investments.

Finally, health IT requirements have caused many physicians to become overwhelmed by back office responsibilities. Most doctors start their own practices because they want to spend their time caring for patients — not dealing with electronic chart, billing, or server issues. Increased technology adoption has caused many practice owners to become more consumed by technology deployments than patient care — a development that does not sit well with many doctors. As a result, more and more physicians are opting to sell their practices to larger health systems to relieve themselves of the burdens of back office and place their focus back on patient care.

While the health IT movement is driving some physicians into hospital employment or early retirement, there still exists a strong contingent who want to continue practicing independently. Moreover, these practices are determined to successfully implement the health IT functionality being advocated by the federal government. This is by no means an easy task. In fact, poor health IT deployments have led some physicians practices to their ultimate demise. Successfully addressing IT demands requires careful technology selection, planning, and change management. The following six tips will help ensure your practice not only survives, but thrives, in the new era of health IT.

Federal stimulus dollars dedicated to EHR Meaningful Use and other health IT initiatives have created a huge market for technology vendors. As such, most IT vendors are working hard to capture as much market share as possible over the next few years. Many solutions providers are making all types of promises, including guarantees for Meaningful Use attestation, in an effort to woo physicians practices to select their products and services. As a result, many doctors’ offices are putting all of their faith in a vendor leading them to the health IT promised land. This approach can have dire consequences.

“Over-relying on an EHR vendor can place physicians practices in a holding pattern waiting for their vendor to upgrade their software to incorporate new functionality to meet the latest MU certification requirements,” says Kosiorek. “The fact is practices could be doing a lot of work toward this end on their own. Waiting on the vendor could cause the practice to fall behind in their implementation efforts. Furthermore, many vendors don’t have the practice’s long-term vision in mind when they make technology recommendations. The solution provider may be more interested in having the practice implement a new server to handle a software upgrade than it is about how the solution holistically affects the doctor’s office. Practices need to make sure they are intimately involved, if not driving, each health IT initiative.”

Being intimately involved in the health IT deployments at your practice doesn’t mean your physicians need to become health IT experts. However, it does mean that you should seek out the expertise necessary to make informed health IT implementation decisions. This support can come in the form of full-time IT employees or contracted consultants. However, it is advised that this support come from a third party — not a vendor.

Obtaining this IT support doesn’t have to break the bank, either. For example, Doctors May-Grant Associates, a 15-physician OB/GYN practice in Lancaster, PA, joined forces with a neighboring urology practice to hire a full-time health IT employee who was shared between the two practices. “Our resident IT expert worked with us to create a list of EHR priorities for our practice,” says Mona Engle, practice administrator at Doctors May-Grant Associates. “She then ensured the EHR solution we selected (Greenway PrimeSuite) was the best fit for our practice in light of these priorities. She continues to drive our EHR implementation and enhancement efforts and works closely with our physicians to ensure the solution meets their needs.”

For some physicians practices, it will be necessary to update perceptions of what an “IT expert” is. For example, some physicians continue to think of an IT person as someone who simply fixes PC, network, and server issues. The IT expert you select to support your healthcare technology initiatives should be much more than this. This individual should be capable of creating a health IT vision for your practice and putting the pieces in place to execute on this plan.

As mentioned earlier, EHR software vendors may promise you the world in an effort to get you to sign on the dotted line. In many instances, these promises go unfulfilled and the practice is stuck paying for an EHR system that not only doesn’t meet its needs, but is actually doing irreparable harm to the business. Vanguard Rheumatology Partners, a three-physician rheumatology practice, provides an unfortunate case in point of a contract gone bad.

The practice signed a five-year contract with Allscripts for the company’s MyWay EHR and practice management solution (since discontinued) back in 2009, part of which was financed by US Bank. Upon implementation, Vanguard began experiencing significant issues with the claims management aspects of the MyWay platform.

“The Payerpath clearinghouse embedded in the MyWay platform didn’t provide accurate EOB data,” says Dr. Carlos Sesin of Vanguard Rheumatology Partners. “It actually got to the point where our electronic claims weren’t being routed appropriately by the clearinghouse and we had to revert to manually resubmitting these claims in paper form, which cost us a ton in staff overtime. The billing and payment delays that resulted put us $400,000 in the red, and the only way to fix the problem was to rip out MyWay, which we purchased under contract. I will never again sign a contract with an EHR company. I have since opted for a pay-as-you-go EHR solution from CareCloud.”

Allscripts let Vanguard out of its portion of the contract, but the practice is still paying approximately $700 a month for the next two years to US Bank for its part in the lease — all for an EHR system no longer in use. Dr. Sesin believes one of the biggest problems with EHR contracts is that they don’t promote vendor accountability.

“Once an EHR vendor has your money through a contract, there’s not much incentive for it to keep you happy,” he says. “With a pay-as-you-go EHR platform, the vendor is motivated to meet or exceed my expectations. If they don’t, I’ll just fire them with little consequence to the practice. The onus is on them to ensure their product and level of service are consistently up to par.”

Software updates, server upgrades, and hard drive capacity aren’t issues physicians should ever have to worry about. An investment in a cloud-based EHR solution can help eliminate much of the technology maintenance requirements often tied to client/serverbased EHR systems.

“Prior to our investment in MyWay (which was a remotely hosted system), we leveraged a client/ server-based EHR from SOAPware,” says Dr. Sesin. “I was always worried about what would happen to my data if the server went down. Also, anytime I wanted to add the EHR software to another computer, we had to download it from their website and load it onto the PC. The same was true for software upgrades. I realized I didn’t want to play IT person, and as a small practice, we couldn’t afford to hire an IT guy to come in to perform these duties for us. With the cloud-based EHR we currently use from CareCloud, upgrades are applied automatically. Plus, we can access the system on any computer with an Internet connection via a username and password.”

With cloud-based EHRs, there also is no hardware to support and office personnel don’t have to worry about backing up data. These characteristics help provide physicians practices with built-in scalability. For example, a practice could easily get new branch offices connected to the system simply by providing the office with computers and Internet access.

Physicians practices are functioning businesses. They can’t shut down for a month or two to implement an EHR. Deploying a new health IT infrastructure without negatively impacting day-to-day business operations and patient care can be a tough balancing act for a doctor’s office. This was a particular area of focus for Doctors May-Grant.

“To streamline the EHR implementation processes, we needed to ensure we had the full attention and cooperation of our clinical and administrative staff,” says Engle. “We did not allow any vacations over the three-week period during which we planned to go live with the EHR. Moreover, we created a ‘super user’ group that was responsible for providing hands-on training to our physicians.”

For Doctors May-Grant, “super users” were a few physicians who had not only demonstrated immediate competency with the Greenway EHR platform, but also had an innate ability to teach the system to their peers. During the three-week implementation period, super-user physicians did not see patients. Their patients were assigned to other physicians in the practice, so that super users were completely freed up to help other doctors get up to speed on the system. The super-user group strategy employed by Doctors May-Grant helped accelerate physician buy-in for the EHR and accelerated the learning process — all while having a minimal impact on business operations.

Many physicians practices have tried to sidestep the costs associated with an EHR implementation by opting for one of the “free” EHR options available on the market. According to MGMA’s Kosiorek, this may not be a wise option.

“Nothing is free, particularly when it comes to EHRs,” he says. “With free EHRs, a practice may not have to write a check, but they’ll be sacrificing a lot when it comes to the flexibility of the system. For instance, you likely won’t be able to customize the software or data to fit the precise needs of your practice. Furthermore, many free options bombard the user with advertising that impedes the usability of the system. In my opinion, the disadvantages of a free EHR far outweigh the advantages.”

So there you have it. Six steps that can help practices cope with rising health IT demands. There’s no denying that health IT initiatives are placing a huge strain on physicians practices, and it seems many doctors’ offices are failing more than they are succeeding. However, by following these steps for starters, you can begin to start realizing the benefits of all the hard work and investments a health IT deployment warrants.

For example, even Vanguard Rheumatology Partners, a practice whose initial investment in EHR software was essentially a technological and financial nightmare, is beginning to see the advantages of an EHR since moving to CareCloud. “The claims management capabilities of our new EHR have gotten us out of the red,” says Dr. Sesin. “Our balance for outstanding claims of 90 days or more is less than $10,000, which is basically nothing. That’s a far cry from the more than $400,000 we were owed prior to the switch. The CareCloud system also comes with a built-in patient portal, which is facilitating patient engagement and lab access. This feature is setting me up nicely for Stage 2 MU.”

Doctors May-Grant has also witnessed the impact an EHR can have on reducing costs and improving quality of care. “Since our EHR investment, our records department has gone from five FTEs to two FTEs, and we have eliminated the need for internal and outsourced transcription labor,” says Engle. “Our paper supply costs have also been cut dramatically. However, most important are the enhancements the EHR has made to patient care. Our clinicians or administrators no longer have to search through paper charts to answer patient questions. We can respond to patients immediately because the answers are all right in front of us in the electronic chart. Plus, paper lab results no longer sit on a doctor’s desk waiting to be reviewed. They are uploaded immediately to the EHR, allowing us to share these results with patients much quicker.”