5 Things I Wish My Practice Management System Did

 

Photo Credit: Martin Kenny

 

I have a bone to pick with many practice management systems. To me, they really don’t help medical practices manage clinics as businesses, but rather are designed with the intention to help a medical practice manage their “claims.” Which is fine, I guess. But if that is the case, then they should be called “claims submission” systems; not practice management systems.

It seems I’m not the only one that is dissatisfied with their practice management system. Physician Practice published results from a tech survey recently and they found that 54% of respondents didn’t think their PM system met their expectations. Here is the link. When pressed for more detail on what they sought, given multiple options, better reporting (62 percent) and more intuitive interface (55.8 percent) topped respondent’s wish list.

I suspect this is the reason why so many practices are poorly managed. It is not the doc’s or the  managements fault, but rather poorly designed software that doesn’t provide pertinent information to make the right business decision.

I’ve put together a list of the 5 things I think that our practice management system ought to do in order to be able to call themselves, a practice management system.

1)     Accounting Integration. It bothers me that we have to use another program like Quicken or Peachtree to do bookkeeping. Right now, our PM system doesn’t know how much money the practice has in the bank. And Quicken doesn’t know what our accounts receivables are. Seems to me that in order to truly be a “practice management” solution, the software ought to perform basic accounting functionality with ledgers, registers and financial statements, as well as perform financial analysis and competitive benchmarking, for example.

2)     Business Management Integration. PM systems ought to show one’s business profit and loss reports and give you an overall snapshot of what’s coming in for the month, what’s going out, and what’s left in one’s accounts. Just like Quicken, the PM software ought to help us with money management, control costs and forecast revenue with business budgeting, profit and loss, track progress and goals. Fundamentally, it should tell me exactly where I’m making money and where I’m not.

3)     Inventory Management / Bar Code Scanning. Imagine this scenario. One’s shipment of seasonal flu comes in and instead of counting them and then stuffing them in the fridge, we take a barcode gun, scan each box so the PM system knows how many flu shots we have in the fridge. Since the software knows how much we pay for each vaccine (thanks to the accounting and business management integration functionality), it can easily add up how much money we have tied in vaccine inventory at any given time. Every time a seasonal flu shot claim goes out, inventory is adjusted.

Every so often, we can run a vaccine reconciliation report (with the inventory management functionality included in the business management integration) to see how many vaccines we’ve given; which when subtracted to our inventory count, should match up with what we have left in the fridge. Boom! We now have done our vaccine reconciliation.

4)     Merchant Services Integration. Considering how many transactions a busy medical office has with copayments, deductibles and balances, PM systems ought to make it easier to manage front office transactions than a traditional cash register. Furthermore, with integrated merchant services from the PM system, there shouldn’t be double-entry between one’s terminal and the software. And I shouldn’t need to buy or lease a separate terminal to take credit and debit cards. The integration would also allow payments to be posted automatically to patient’s ledger to eliminate double entry.

Additional features should include storing credit card information and emailing receipts. I’d love to be able to say to a person checking in, “I see you have a $35 copayment… would you like for me to put that on your Visa account ending in 1234 that we have on file? Oh, and ma’am…. here’s the receipt for you. I’ve also emailed you a copy for your records.”

Merchant services would also help with payment plans and recurring billing.

5) Patient Relationship Integration. What if, we could merge all the data from our EMR’s and our PM and use the data to get and keep satisfied customers? What if, we use all the data we have to create an overall strategy that enable us to learn more about our customers/patients/parents, thus developing a stronger, lasting relationship.

Just like Saleforce.com creates software to manage and nurture a company’s interactions with customers, PM systems (coupled with the EMR data), has the potential to help us track and manage our patients in a much more engaging way. Not only from clinical stand point but also from a marketing, customer service and support stand point.

For example, we document every single patient phone inquiry from parents. But I couldn’t tell you what are the 5 most common reason people call our office for. Let’s say parents call more often for feeding issues and questions. That would be helpful to know so we can address the issue and not have to answer that same question over and over again after they left the office. Or perhaps create a pamphlet that specifically address the most common issues. We transcribe each call; the data is in there. It just needs to be put into context.

Email and text message, and outbound reminder phone calls should also be part of the patient relationship integration functionality. But equally important is the data it collects. For example, is text messages or email messages more effective to reduce no-shows? Do people generally respond to a female voice or a male voice when reminding them of their appointments? This data, coupled with no-show data, could easily give you an idea which one of these methods are more effective.

There are hundreds, if not thousands of examples I could give on this topic alone.

Those are my top five, but why stop there? So I’ve put together a few more I’d like to include. What the heck!

6)     Web Site Manager. Our website should not be a separate software entity. It should communicate with our PM system. If I can order a pizza from the local pizza joint on their webiste, I should be able to make an appointment online. I know there are many PM that allow this functionality, but they are still very limiting. Patient’s ought to be able to have access to view upcoming appointments, fill out forms, see treatment plans and account balances.

Patients should be able to get a copy of their EOB’s (we already scan all the EOB’s so the data is electronically stored) and their statements to make payments online. And those payments should automatically update the patient’s ledger.

7)     NCOA Verification. Address verification should be a standard option  that enables practices to check national databases to identify postal customers that have relocated. By comparing mailing lists against the database, it ensures the accurate delivery of patient statements and reduces undeliverable mail. The PM system should notify the practice in real-time when there is an address correction and update it in our PM’s patient files making manual updates a thing of the past.

8) On the job training. This one isn’t really a functionality of the system per se, but it would improve the functionality of the PM ten fold. Here it is, I would make every single PM developer, computer engineer and PM software designer that worked on our PM, work at least 6-months at our medical office doing front-desk work, doing billing type stuff, posting payments, submitting claims, working denials, running and reading reports, as well as data entry stuff like inputting demographics for 3 siblings with virtually the same demographic data 3 different times. Once an engineer really knows what it is like to post a gazillion claims a month, I’d bet there would be improvements to the PM system ASAP.

Oh, did I mention the PM should also continue doing all the stuff it does now?

I’ve heard many times (in fact, I’ve said it myself) that doctors are not good business people. But nobody agrees that doctors are dumb. Maybe, it is not that doc’s are not good business people, but rather the software tools they are given disable their ability to become smart business people. Even Warren Buffett couldn’t make wise choices about his business investments if he didn’t have the right information available to him.

8 thoughts on “5 Things I Wish My Practice Management System Did”

  1. Hi,
    I read your comments with much interest. I think the word should be integration. Quickbooks is great for accounting, but not much else. but did you know you can connect the information from quickbooks to other pieces of software?
    It sounds as if you need a rather simple inventory system (barcodes are a given in those) with integration to quickbooks. In addition, there could be additional integration with other pieces of software as needed (depending on your specific requirements – one size does not fit all!).
    I am aware the “medical” software costs thousands – I do not know why. I have worked with several Dr offices with similar issues and tried to help them make the best of what they had.
    Just my 2 cents.

    1. Thank you for your 2 cents.

      I’m not convinced that integration is the solution. However, if integration gives me what I want, then let’s do it.

      Brandon

  2. What happened to the “I can’t argue with your wish list” comment? I like that comment better.

    Like you, I am a consumer and software user before anything and I can very much see your POV. This discussion is really interesting to me (though my responses have been shallow). So, keep it up.

    Perhaps what I’m asking for is unrealistic, but I think you agree with my fundamental issue, which is, for the most part, health care software stinks. Actually, it sucks *(&D^* Ba(*&. It is poorly designed, too complicated, it is way too expensive, and very rarely delivers on its promise.

    No question. Frankly, the bigger you go in this business, the more likely it is that the software sucks, too.

    I’m disappointed at what I’m getting (and being told what I have), especially when one sees things like Evernote, Mint.com and Dentrix, which is leaps and bounds ahead of any medical PM/EMR that I’ve ever seen.

    OK – first, I know nothing about Dentrix, so tell me why it’s so cool. It certainly seems that it should be translatable into, say, peds. Given that Henry Schein owns it and used to own some fairly large PM, there must be a reason it wasn’t.

    Second, let’s use Evernote as an example of how integration is a challenge as well as the specific demands of the customers. Evernote does ONE THING (really) and does it well. Even a generic billing system has to do MANY things and has to do many of them VERY DIFFERENTLY. Using just claims as an example…do you know how many variables PCC carries on a per-payer basis just to generate a paper claim?

    135

    And some of those variables have many sub-sections. And if ONE of them isn’t filled out right, you don’t get paid.

    Meanwhile, we have to adjust these variables – some of which involve process logic that goes beyond many users’ “interest” – on a practice by practice basis. We can literally have 2 clients in the same building, but practice A fills out their forms one way and practice B, another.

    Have you ever seen the great Jonathan Bush/Athenahealth videos on this subject?

    So, meanwhile, a debate ensues on SOAPM about how a change to 6 CPT codes is going to bring pediatric billing in the US to a screeching halt – and I think it’s true – and I sit there and say, “Boy, that’s job security for me and everyone else in this business.”

    Evernote doesn’t have to deal with that.

    mint.com’s circumstance is more complex, but again…their integration with other vendors is not the same as what you in private practice have to deal with. Anywhere close to it.

    And my argument is that very few out there actually help me do my job (or the doc’s for that matter) better. And that is what software is supposed to do, help me do my job better.

    I couldn’t agree with you more (note I took out the compliments). Even PCC doesn’t do enough. Most medical software is designed to do just enough to keep the practice from calling you back.

    Still…if I deliver the world’s perfect software, too many of your peers would refuse it. Sad, but true.

  3. Some quick responses:

    I’m not suggesting “integration” as much as I’m asking for “incorporation.” I think all this functionality should be a part of a suite of products. In other words, I don’t need for my PM to interoperate with Quicken, I want my PM to be my Quicken.

    That’s just not realistic, though. The broader your software demands, the shallower the delivery. What company on the planet has the expertise to develop and support a product like Quicken AND (for example) a pediatric-specific PM? None.

    Ask yourself: how many vendors do both PM and EHR well? Almost none.

    The reason we are unwilling to pay for these services is because it shouldn’t cost extra. These things should be part of the package.

    …but having them be “part of the package” means they will cost extra, whether they are a line-item or not. Those features don’t come free, so the price of the software will rise accordingly.

    Back to what I think is an important and fundamental point: if everyone is producing simple claims-management software, why is it so expensive? That’s a good question…I’d put the answer fundamentally at two places:

    1) Quicken has, literally, millions of potential customers. Their market is more than just medical practices, obviously. You point this out yourself and it shouldn’t be underestimated. PCC has a few hundred customers around the country.

    2) Physicians and their offices *really don’t like to be told what to do*. As a result, our support costs are exponentially greater. We spend a lot of time explaining to our clients *how to run their businesses*. Quicken doesn’t do that…they produce some documentation and then tell you to go for it. Most PM vendors, even the bad ones, do more than that. And the people-cost is giant!

    There are days when, believe me, it would be a lot easier just to sell the software 🙂 It’s certainly makes releasing our products in OSS fashion more interesting.

    1. Hey,

      What happened to the “I can’t argue with your wish list” comment? I like that comment better.

      1- Perhaps what I’m asking for is unrealistic, but I think you agree with my fundamental issue, which is, for the most part, health care software stinks. Actually, it sucks *(&D^* Ba(*&. It is poorly designed, too complicated, it is way too expensive, and very rarely delivers on its promise.

      2- I’m not going to pretend to know how much developing software functionality cost or how easy it is to implement but as a consumer (which I’m actually an expert at. I buy things almost everyday of my life), I’m disappointed at what I’m getting (and being told what I have), especially when one sees things like Evernote, Mint.com and Dentrix, which is leaps and bounds ahead of any medical PM/EMR that I’ve ever seen.

      3 – Reality is, you are the wrong person to have this debate with. It is evident that PCC has gone to extraordinary lengths to help pediatricians understand their business, their practices and to some extent, their true purpose as pediatricians (ie WCC vs Sick ratios). And my argument is that very few out there actually help me do my job (or the doc’s for that matter) better. And that is what software is supposed to do, help me do my job better.

  4. I knew I shouldn’t have opened the link before breakfast. Now my head is going to buzz until I can find something else to distract me 🙂

    I can’t argue with your wish list very much. There are a few items I could push on a little bit, but they’re fundamentally sound.

    Note, however, that they all have a single, unifying theme: integration. In each instance, the vendor would have to work with one or more third parties. As a vendor, I will suggest that this is *very hard work* – if not hard, at least time consuming. It’s generally not done, or done well, by most developers because it’s largely political and not not as much technical.

    That said, I also look at your list and will suggest that most of our peers are unwilling to pay for the work required to deliver these services. It has nothing to do with whether or not the features make sense or pay for themselves. We’ve had to drag many of our clients into the world of electronic claims. I bet 1/3 of our clients still track their immunizations by hand (although we’ve had an automatic tracking for 25y). 40% of our clients have not looked at their PCC clinical and financial dashboards in a year, etc. And these are the folks who have PAID for the features!

    Most pediatric offices operate with their heads down, as you know. Even if we integrated seamlessly into some WWW/patient portal…most practices wouldn’t want to pay the $$ it costs to maintain and develop that service, and even fewer are interested and capable of doing their portion of the WWW site upkeep.

    This makes me sound more cynical than I intend to be.

    1. I knew I shouldn’t have read your comment before getting some work done this am. I wasn’t going to let it go until I responded.

      I’m not suggesting “integration” as much as I’m asking for “incorporation.” I think all this functionality should be a part of a suite of products. In other words, I don’t need for my PM to interoperate with Quicken, I want my PM to be my Quicken.

      The reason we are unwilling to pay for these services is because it shouldn’t cost extra. These things should be part of the package.

      My version of QuickBooks cost like $150. QuickBooks Premier cost $400. Quicken’s inventory management software, $99 bucks. A full professional version of MS Office cost $500 and I get 7 different programs with the package. Not to mention the software could potentially last me 20 years.

      But my “claims management” software (because that is what it ONLY does) cost thousands of dollars per user plus thousands of dollars in support fees a year.

      I know… I know… PM development companies aren’t large org’s like MS or Quicken that mass produce products. But pediatric offices aren’t big org’s either. For the most part, we’re mom & pops shops. Thus, the software should be priced accordingly.

      Regarding people not using the features I’d like to say several things. First, how many people use Pivot Tables in Excel? But it is there if someone needs it because it has to be there.

      Secondly, check out this great article written by Marc Headlund (http://blog.precipice.org/why-wesabe-lost-to-mint) where he talks about why his company failed. There are many lessons in his piece but he sums it up with this paragraph:

      “…not being dependent on a single source provider, preserving users’ privacy, helping users actually make positive change in their financial lives — all of those things are great, rational reasons to pursue what we pursued. But none of them matter if the product is harder to use, since most people simply won’t care enough or get enough benefit from long-term features if a shorter-term alternative is available.”

      Anyway, I could go on and on… but I have to get back to my “claim submission” software…

      As always, thank you for you comments and your perspective.

      Brandon

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