Stimulus & EHR: A news interview with an ObGyn practice and MBA HealthGroup


$634 Billion Healthcare Reserve Fund?

Wait, I thought we were talking about only $30 billion? Apparently the Obama administration is putting together a plan that would allow for this $634 billion to be used over the next 10 years to completely rebuild America's healthcare system.

This statement is a little scary:
Money for the reserve fund is expected to come from limiting tax breaks for the wealthy and tightening payments to insurers, hospitals and physicians.

Tightening payments to physicians should be an interesting battle.

The CNN article can be found here

The "Meaningful Use" Timeline



The more I talk to physicians and practice managers, the more I realize how unclear the importance of the stimulus package and HITECH Act are to most. The two most difficult concepts for people to grasp are:

1) if you already have an EHR, you ARE eligible for these incentives. In fact, you're in a better position than anyone else. Acheiving "meaningful use" should be relatively easy considering what you've gone through for implementation.

2) if you haven't yet purchased an EHR, you have quite a bit of work ahead of you just to be where you need to be on January 1st, 2011. The graphic below is what I'm calling my "Meaningful Use" timeline. It gives what I believe are some very real estimates of time to acheive "Meaningful Use" by 2011. There's no doubt that many practices could move faster than this, but in my experience, this is something you absolutely don't want to rush if you don't have to. Unfortunately for most, it won't be long before people are rushing to make EHR a reality in their practice.
















5 Ways to Prepare for your all-expenses paid trip to EHR land.

Well, not totally free...there will still be sweat & tears. You'll probably lose an employee or get into an argument or three. Chances are, one week into the implementation you'll say you're calling it quits. Your implementation team will talk you off the ledge and you'll realize that this will all pass in time. A physician will refuse to touch his computer because he wasn't part of the "buy-in" discussion you had with everyone. When training starts, it will be impossible to get all the physicians in one room even if you're a two doc practice. Write down their excuses for not being there, it'll be funny a year from now.

If you don't already know, it will be a challenge. But there isn't a single practice I've seen that would ever give up their EHR after a year of having it, and if you tried to take it away, you could get really hurt (I've been verbally threatened). The reality is: 2011 is not as long away as you think. If you think you're going to start your EHR selection and implementation process in 2011 you're in for a big surprise. There has to be "meaningful use" occurring on your EHR...and that takes a year anyway. Not to mention that the world just doesn't have enough implementation people to get all these implementations done! If you're really smart, you'll get started now. So here are what I see as the best ways to prepare your practice for taking advantage of the stimulus package and the incentives soon to come.


  1. Get buy-in...like...tomorrow. Don't put it on hold until next week. Don't save it for after spring break. Do it now. The sooner you have buy-in from everyone in your practice, the better you'll all feel about moving forward. If you don't, you'll wish you had. Identify the saboteurs and address them from the beginning. Include them in the process. Let them make decisions with the group and explain how the EHR will impact their day-to-day. I see this as the biggest hurdle a practice can face if not dealt with early on. If any physician wants to try to retire before the EHR comes, you're in trouble. Get them on board or have them pack their bags for Florida early because the last thing you want is a paper process running parallel with your electronic process.
  2. Narrow down the possible vendors. Did you know there are over 300 EHR/EMR vendors out there? Don't just Google "Pediatric EMR" and expect to come up with anything useful. You'll end up with a program written by a 16 year old out of the basement of his parents' house when he gets the time between Halo games on his XBOX (I didn't actually Google-research "Pediatric EMR", so I hope I didn't offend anyone). The worst thing you can do is invest in an EHR that isn't going to be around in 5 years. Or worse yet, it's around but only because it lives on your server, and there isn't a person (in this country or any) to support it. Start with your state medical society. Many times they have already narrowed down the long list to a handful. The Medical Society of the State of New York narrowed their list down to 6 vendors and they still get asked to give practices the top three. It's not easy to watch all those demos, deal with all those salespeople and expect to actually get anything out of it other than a headache. You can also look at your specialty journals for their recommendations but many times they are specialty specific EHR solutions which may sound great but aren't always the best solution. KLAS (http://healthcomputing.com/ ) has users rank software packages as well, but they don't rank everything. For instance, many products that smaller practices couldn't usually afford have been made affordable through hosted offerings, and they can be much more functional than some small practice products without any of the servers or other IT requirements.
  3. Work~~~~flow. This part can be hard because a lot of implementation teams don't perform any workflow assessment. They'll train you on the system, wish you luck, and head back to where they came from. Force them to look at your workflow. It may cost you some extra money, but the majority of implementations go over budget by around 50%. This isn't a place to save money, do it for your sanity and the success of the project. You can start working on workflow now and eliminating inefficient processes, but you won't really know how it'll all flow until you choose an EHR.
  4. You gotta have IT. Information Technology. You'll need to have things in place before you even get the IT with the EHR. If you're looking at hosted EHRs, make sure you get yourself a high-speed Internet connection. It's probably worth having a wireless router installed in your office by your local IT guy if you plan on carrying around tablets. Ask every vendor you talk to about what they've had good experiences with...if you're talking to the salespeople, they may have no clue, so have them ask some implementation folks. I've heard a lot of good feedback on Fujitsu tablets. Look for lightweight products that feel sturdy. Or maybe you want desktops in each exam room? Great! Now take a look at the furniture that exists for that type of thing. Consider mounting a monitor on a swivel on the wall so you can show the patient what you're doing on the EHR. This is something many patients LOVE. Finally they get to see what their doc is doing for them. Remember, kids will ruin every piece of technology you leave in an exam room, so be careful.
  5. Start planning for scanning. You can even outsource it if you want. There are a lot of companies out there that will scan all your paper records for you. But...think long and hard before you scan 20 years worth of data for your 60,000 patients. When are you really going to have to look back over a year for anything. Save yourself some time and money and put those old files in storage somewhere. There are practices out there that may have their reasons for scanning everything, and I'm no doctor, but I have a hard time buying into paying thousands of dollars in salary or scanning services to put in information you might access once.

This list could've gone on forever, but I said "5 Ways..." so I'm sticking to it.

The Allscripts and Perot Stimulus Webcasts

For those of you who didn't have the opportunity to watch today's webcasts on the stimulus and its impact on the healthcare industry.

Perot Systems presentation can be here (PDF) and will be able to be found here as soon as they post it (Harry Greenspun said it will be available later today)
Allscripts presentation can be found here (PDF) and you can find out more information from them here. Allscripts also has a HITECH Act FAQ you can read here (PDF)

A Stimulus Day

Since yesterday's signing of the Stimulus Bill, there's a lot going on today. I'm planning on attending 2 or even 3 webcasts from different companies with vested interest in the HITECH Act and comparing notes. I'll be posting a list of questions that are asked and important points that come up from each presentation later on in the day. Stay tuned!

Stimulus Package and Physician Incentives


A day before the stimulus package gets signed, everyone seems to be doing a webcast about how these incentives will be distributed to physicians. Twitter has worked wonders in allowing me to stay up on all the most recent developments, many of which come from John Moore at Chilmark Research. Here's his post. His take on it: A lot of money, and too fast. Practices won't want to miss out on the incentive, so implementations may be botched and it could cause more harm than good. That could definitely happen. Hopefully with this amount of money, vendors will push more comprehensive implementation packages and spend more time with the practice dealing with workflow and functionality.
The chart above is one he put together showing that starting in 2011, physicians will be reimbursed at different rate each year. The bill doesn't say whether or not these are CCHIT electronic medical records or not, and it seems that physicians already using an EHR will get the same financial reward as one that chooses to adopt in 2011. The bill does talk about connecting to an HIE or RHIO for coordination of care but in many cases, RHIOs aren't even ready for that type of communication. Some are limited to only a single feed for lab results (not even orders)...so I'm interested in how that will evolve.
To join a webcast put on by Allscripts discussing how the incentives will work, register here

Is this Stimulus going to Make or Break Healthcare?

I've been reading all the Op-Eds, Blogs, Twitter posts for the past few weeks just trying to determine what the concensus is on this healthcare stimulus package. The only conclusion I've come to is that like anything in politics, there is no concensus. And of course, there is nobody that can forsee the impact it will have on patients, physicians, or the industry as a whole. So this is my attempt at compiling a list of interesting articles that can either confuse you to the point of exhaustion, or help you form your own opinion.

Feb 16th:
Don't sacrifice privacy when digitizing medical records:http://blogs.usatoday.com/oped/2009/02/dont-sacrifice.html

Stimulus provides preview of health battle ahead (NPR) http://www.npr.org/templates/story/story.php?storyId=100671453

Feb 13th:
Healthcare Reform Shaping up to be as Divisive as Stimulus Package:
http://albany.bizjournals.com/albany/stories/2009/02/16/story7.html?b=1234760400^1777860&ana=e_bjt (thanks twitter.com/riggrl)

Senate's HIT funding FAQ (PDF): http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf

NPR: Stimulus Provides Preview of Health Battles Ahead http://www.npr.org/templates/story/story.php?storyId=100671453

Steve Pearlstein for the Washington Post writes "Bloviation vs. Reality on Stimulus Health-Care Provision"
http://www.washingtonpost.com/wp-dyn/content/article/2009/02/12/AR2009021203527.html?hpid=topnews

An updated article from Feb 11th on Bloomberg says Patient Privacy advocates are claiming victory in new bill: http://www.bloomberg.com/apps/news?pid=20601087&sid=aOQrsih0y1BU&refer=home

A copy of the Stimulus Plan: http://big.assets.huffingtonpost.com/finalstim.pdf

Feb 11th:
The Wall Street Journal criticizes the healthcare stimulus package: http://online.wsj.com/article/SB123431432273870909.html

Feb 10th:
New York Times writes about the EMR and how to spend the stimulus money wisely:
http://bits.blogs.nytimes.com/2009/02/10/electronic-health-records-how-to-spend-the-money-wisely/

Feb 9th:
Betsy McCaughey writes "Ruin Your Health with the Obama Stimulus Plan" http://www.bloomberg.com/apps/news?pid=20601039&refer=columnist_mccaughey&sid=aLzfDxfbwhzs

Improve Practice Financials in 5 Steps

All providers who enter the medical field generally do so to meet a common goal, providing good care to their patients. With this goal in mind it is often conflicting to set a price to the care provided. It is even more challenging to make financial decisions that can impact your patients directly or indirectly. Ultimately physician and provider owners of medical practices must face this dilemma and be successful with their choices to stay in business. MBA HealthGroup can provide practices with many ways to access the financial health and well being of the practice in a practice evaluation. There are some important elements that can be easily implemented to ensure the practice enjoys good financial health. Although these suggestions cannot single handedly solve financial challenges, if implemented they will create solid footing from which a practice can thrive and grow.
Tips for medical practice financial health:
1. Payment at the time of service: Collecting co-pays and any cash payments before the visit ensures some form of collection is happening. People expect to pay when they visit a provider office, however they usually will not offer it unless requested. Front desk staff training is crucial in the successful collection of these revenues. If collected at the front desk, preferably during check in, (or check out for services or medical equipment) money is also saved in mailing statements and back end collections.

2. Timely charge and payment entry: Entering charges the day of service is ideal, however if they are delayed by even a few days the payment cycle can be impacted and financial analysis skewed. Delay in payment entry creates loss of revenue because additional statements may be sent to patients, or time lost in follow up calls to insurance companies.

3. Regular fee analysis and updates: Insurance companies change their rates annually, fees charged by the practice should be formally assessed on a regular basis, as well as during the payment entry process. If a payment by an insurance company matches the charged amount this indicated the charge is too low and potential dollars are lost from other payers who have a better rate.

4. Timely payment plans and follow up: Patients who want to work with you to pay in good faith are patients who will return in the future and efforts should be made to create a workable solution. Although the collections process is always an option for uncollected balances, it is always best to work with patients as much as possible. It is recommended that all payment plans are limited to 6 months and appropriate follow up is set in place to track success.

5. Maintained Credentialing: All payments begin and end with appropriate credentialing. Work with your carriers to ensure credentialing is up to date and complete or payments may abruptly stop. It is also essential to remember that any new providers, changes in address , name or tax ID must be updated with credentialing all the carriers to ensure continued payment.
These are just a few simple ways to create improved financial health at your practice so that providers can remain true to their ultimate goal: superior patient care.

Kristy Hart, MBA, PT
Healthcare Consultant, MBA HealthGroup