For today’s AwesomeCast, we get to talk to Dr. George Rogu. If you have spent time on SOAPM, you know who Dr. Rogu is. A troublemaker. That is right. For those of you that don’t know, Dr. Rogu works for RBK Pediatrics in Long Island, NY.
I think this episode is going to be one of my favorite episodes of all time. I learn so much from Dr. Rogu. I even took notes. Dr. Rogu shares with us his experience negotiating with big payers. You will not want to miss the technique he used to pester executives at the insurance company and how one day he got a call from the insurance company executives asking him to tell his patients to stop calling them. He also gives great advice on how to prepare and execute contract negotiations with insurance payers.
We also spent time talking about technology and the approach Dr. Rogu has taken in order to find the best of the best as it relates to technology.
It is a great AwesomeCast. You should definitely listen or watch the YouTube video below. I think you’ll want to take notes on this one.
To listen to the AwesomeCast, click below.
You can also download the audio version of the episode on iTunes
For this post, we are going to be looking at how we can leverage what we already know from our experience of implementing and managing an EMR system in our office.
If you missed the previous post, scroll back or click on this link.
Chip, for those of us that are thinking about replacing our EMR, surely we can take advantage of the lessons we’ve learned and use them during this transiton, right? What are some of those lessons?
Take advantage of the fact that you should have suffered through the learning process of managing your IT infrastructure at this point. If your remote office connection is finally broad enough, you’ve nailed down the tablets you like to use, and your wireless interference issues are resolved, your second EHR experience will benefit greatly as a result.
If it happens that you still have significant hardware or networking problems with your existing EHR, you should make every effort to resolve them before your new EHR is in place or you will drag your bad experience into the new world.
Now that I’ve figured out my wireless challenges and hardware needs, what is next in terms of leveraging our experience?
When you migrated to your first EHR, you had to answer important questions about the flow of people through your office, many of them for the first time. How do we get paper into the EHR? How do we find our nurses? How do we manage orders? Who is in charge of our clinical protocols?
Use this understanding to your advantage and identify how your new EHR will fit into your existing patterns.
Work flow needs, check. What else?
This time around, you know how much and what kind of training you need. Chances are that you didn’t get enough training the first time around. Or that you had access to sufficient training but not everyone – particularly the doctors – took advantage of it. Recall how your first EHR on-line went and mandate full training for the new EHR.
No matter how cool the new EMR appears, there seems to always be featrues that the docs love in the old EMR that the new EMR doesn’t have. What can we do about that?
Every EHR has features in it that the users love, even if the balance of the EHR feature set is negative. Isolate those few features you can’t imagine living without and discuss them with your new vendor. Perhaps the new EHR has a similar or even better feature set.
The real trap to look for here are those features that have become a definitive part of the flow in your office that will no longer exist, for better or worse. You will need to figure out how to redirect the flow in your office before you go on-line.
One of the things that bores me to tears in business, is having to read contracts. But of course, contracts are very important. Especially the ones you have to sign. Talk a little bit about what to look for in our new contract with our new EMR vendor?
Your last EHR contract may have made things difficult. If there are any terms from your existing EHR client that made things difficult for your practice, such as the inability to extract data from your own EHR, now is your chance to do it right.
All this time we’ve been talking about the EMR, but what about the practice management system?
The often overlooked project in any EHR installation is the relationship with the billing process. At the very least, all of the questions you’ve addressed relating to your EHR need to be addressed, again, with your PM. Will you need to change PMS? Do you have new third party relationships to manage (such as a clearinghouse)? Are there features of your PMS that you can’t live without or will require significant retooling once it changes?
Too many practices overlook the impact of a system change on the most important department in the office.
I hope you found this discussion useful. By the way, I know Chip tried very hard to keep this discussion vendor agnostic. If you work for an EMR vendor or have switched EMRs and have something to add or correct Chip on, feel free to drop me a note.
Today, I have another guest post. This time it’s from Dr. Suzanne Berman MD, FAAP. Dr. Berman is also a contributor to Survivor Pediatrics. In this post, she gives insight into the real benefit of having a EMR. For example, many docs believe that a EMR will help them chart faster. But as Dr. Berman points out, that is not always true.
The real benefit of an EMR isn’t being able to put data in/chart faster – this is great if you can do it but not everyone can point/click/type faster than they can check boxes–
…the real benefit of an EMR is getting practice-wide data quickly OUT of it.
When docs test drive EMRs, they want to see “How do I put in the vitals? How do I issue an Rx?” As far as getting data out, they want to see patient-specific, single-patient data: “Show me the kid’s growth chart.” “Show me their pattern of no-shows.”
But the real ROI is learning how to get data OUT – report writing and so on. Most docs never learn this, or expect the administrator to do it all.
I’ve posted on SOAPM before about how we found $3K/month in lost revenue in labs we weren’t billing for by cross-checking the number of, say, strep tests documented in the chart vs 87880’s billed for – at a cost of $100/month. Is $3K/month a huge cash cow? Nope, but it’s something we wouldn’t have had otherwise.
We get another perhaps $1000/month for running reminders on missed E&M, 99050, etc. and we already run a pretty tight ship. Other practices have found similar results from cross-checking vaccines, etc.
By reporting on how many different days I saw kids at our local hospital (place of service 21 or 22) I can give our practice’s accountant a nice list of work-related mileage from our office to the hospital. This is maybe $500/yr in tax savings for me and my husband. Is this ginormous? Nope, but since the report is already there and it takes 2 minutes to run and print, $500 earned in 2 minutes work is pretty good.
Having the computer do the various annual reports that are required of the various programs we participate in saves my nurse administrator time. How many VFC vaccines from a certain lot did we give between date A and date B to self-pay vs. Medicaid patients? How many H1N1 vaccines did we give during a period? Point, click, print, fax, move on. No hand tabulating. No adding up long columns of numbers by hand.
There’s a new Framitz machine that’s now CLIA-waived! It’s on sale, $5000, and the cost per test is $3. Insurance reimbursement is $8. Is it worth it? Depends on how many Framitz tests we sent out last year — and with a couple clicks, I can see what the ROI on a new Framitz machine would be.
I don’ t expect everyone to be the data mining geek that I am – but I posit that you will never reap the rewards of an EMR if you don’t know how to get practice-wide data intelligently OUT of it.
And that’s the trouble with spending a lot of time on scanning old data into the EMR – it’s clunky and time consuming, and you have to do it, but the data you’re putting in can’t be extracted in any meaningful way (unless you are doing some really awesome indexing) to do the cool things I’m talking about.