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Bringing Technology to the Little Guys

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IPAs help small practices find a management system and EMR that really work.

Despite recent rules from the Centers for Medicare & Medicaid Services that relax the circumstance whereby a hospital can help fund a physician practice's electronic medical record needs, many smaller physician practices (five physicians or fewer) fear they're being left behind as healthcare enters the information age. Many can't afford to buy an EMR on their own, and often no one steps forward to pay for one for them-so they continue with paper processes out of necessity.

But there may be some help on the way. Some practice management systems are working with independent physician associations to try to break into the small-practice environment--helping physician practices that otherwise might be forced out of business retain their independence.

For David Fairbrook, MD, getting an EMR and practice management system for his practice, the Clinic at Panorama City in Lacey, WA, was like the old sales saw: He couldn't afford not to get one.

"It was get something done or be out of business," he says of his decision to install a system from St. Louis-based Purkinje Inc. that Northwest Physicians Network, a 420-physician IPA in Pierce and south King Counties near Tacoma, WA, recommended. "It was a desperation move that worked out fine."

Frederick A. MacCornack, PhD, says NPN, the state's largest IPA, wanted two things from an EMR: integrated billing and practice management software and better clinical integration among its members. An epidemiologist by training, MacCornack, NPN's chief systems integration officer, says he was looking for a system suitable for small practices, which make up the majority of his member physicians-about 250 of whom own the IPA.

"Typically, these are pretty small offices-about two to three practitioners," MacCornack says. "This is Main Street medicine. Seventy percent of the providers in America are like these."

Purkinje is using IPAs as the key cog in its marketing and distribution system. The company trains the IPA staff to implement the EMR and support it. About 25 percent of NPN's physicians are primary care; the remainder represent 34 specialties. Four of those practices were started on a pilot basis in spring 2006.

NPN employs two full-time employees to install the technology and train and support local practice managers. MacCornack believes this solution will work because it's an ASP model that doesn't depend on Purkinje for support.

"It has to be an ASP to work in small practices," he says, adding that in his market, about 17 percent of the offices have adopted an EMR-most of them not successfully. "The vendor typically makes its money on support, but it's killing the practices.

"We know these physicians because we're handling their claims and we know their office staff and their foibles and can work around that," MacCornack says. Further, the practice itself is paying the subscription, so staff members are given an incentive. Typically, the practice starts out with the e-prescribe module, shortly thereafter the practice management system, and then the EMR component.

The practice management portion is critical, however. "We have done assessments on 24 practices, and there isn't one that isn't in serious financial trouble," MacCornack says. "They don't have the resources to hire experts in coding and billing, so they run amok because they can't keep up with the complexity of it." After installation, he says, coding, reimbursement and turnaround time is far better than they were performing.

"For instance, we have many practices with AR about 90-120 days. With the new system, we're getting turnaround time in the neighborhood of 10 days now."

The subscription isn't cheap at between 5 percent and 6.5 percent of collections, but Fairbrook is a believer, as his savings easily pay for the outlay. In the first five months of 2006 before the system, his overhead hovered near 62 percent of revenue.

"Just recently I calculated my first five months of this year, and my overhead was 52 percent," with the major savings coming from dictation and coding. Coding is also more accurate, meaning he often gets his checks "in 10 days instead of 30."

-Philip Betbeze

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