In a previous post, I asked the really important question: Is Revenue Cycle Management Sexy? I was amazed and impressed by the discussion that spurred out of that post. People were talking revenue cycle management details in the comments, on Twitter and even on their own blogs about how revenue cycle management is indeed sexy.

Turns out that a number of doctors wouldn’t be practicing medicine today if it weren’t for revenue cycle management companies that support these doctors. Keeping doctors in business is sexy to me. I know that the media often spins revenue cycle management as the rich (doctors) getting richer. They also love to talk about revenue cycle management companies taking such a huge chunk of a physician’s reimbursement. Let’s look at these two factors.

Are Doctors Rich?
First, it’s a little bit of a misnomer that doctors are all rich. Doctors don’t do anything to help this image since so many of them drive around in their high priced Mercedes and BMWs. There are many doctors (specialists top this list) that do make a very large amount of money. Many primary care doctors and certain specialties make much less. Don’t get me wrong. Every doctor I know is making plenty of money to live and live well. In fact, they’re making more than the average American. Although, when you look at their overhead, medical school expenses, etc you wouldn’t classify most doctors as rich.

Plus, let’s be honest for a minute. Many doctors are great at caring for patients and terrible at running their practice. Most physicians aren’t business people. There’s nothing wrong with this. In fact, some of the very best doctors are terrible business people. In these cases, many doctors turn to revenue cycle management to help them improve the business side of things. In some examples, no revenue cycle management assistance for a practice means the practice goes out of business. Hard to classify a practice that can’t collect money and goes out of business as someone that’s rich.

Revenue Cycle Management Company Fees
I’m sure if we looked across the spectrum of revenue cycle management companies, we could likely find some bad actors that are really gouging doctors more than they should because the doctor is in a vulnerable position. However, I think this is more the exception than the rule from what I’ve seen. In most cases where I see revenue cycle management in play, it’s because the practice for one reason or another couldn’t keep up with the demands required to do good revenue processing or didn’t have the expertise to do it well.

The problem is those doctors who are great business men don’t understand why their colleagues would allow a company to take a percentage of their reimbursement. What these great businessmen/doctors seem to miss is the choice that most doctors are really making when they choose to get assistance with their revenue cycle from another company.

The real choice for many doctors is whether they’re ok paying 7% of their reimbursement in return for a huge increase in how much reimbursement they actually receive. It’s just basic math really. If I can increase a doctors reimbursement more than the percentage I take, then it’s a good choice for many (definitely not all) doctors.

Could the doctor just increase the reimbursement themselves without having to pay a fee to someone else? Sure they could. In fact, many try this approach over an extended period. Then, many realize that they’re not very good at that part of the business. They realize that an outside revenue cycle management company can help them find missed claims that will now get paid. They realize that revenue cycle management companies can help those providers get paid faster.

Revenue Cycle Management and EHR
Some of the most popular EHR companies are built around this fact and offer the EHR for free or nearly free as a compliment to the core revenue cycle management. Plus, more and more EHR companies are building in some sort of revenue cycle management component. In many cases this is a good way for an EHR company to generate revenue, but for many practices it’s also a great service for them.

Of course, I’ve also heard from the many EHR vendors who don’t provide these revenue cycle management services to their providers. They usually give me an exasperated “How can doctors pay of their reimbursement to these companies?” A part of me understands this exasperation completely since I’m an entrepreneur like these EHR executives. If I were in a physician’s shoes I’d figure out the business process myself instead of giving a big chunk of my reimbursement to another company. This just ignores that many doctors can’t (or in many cases don’t want to) figure out the business process. In these cases, a percentage of their reimbursement is a better business decision.

Conclusion
The biggest challenge to revenue cycle management is doctors don’t want to admit that they need a revenue cycle management company. By doing so, they’d be admitting their not business people and that’s a really hard thing to do. Although, in many cases it is the best business decision.

Next up in my series on revenue cycle management I’ll talk more about the relationship of EHR and RCM.

In reaction to my post discussing a physician’s enlightening reaction to meaningful use one commenter highlighted what I think is a really interesting question: Are All Meaningful Use Implementations Created Equal?

The interesting thing is that the doctors comments mentioned above essentially highlight his belief that meaningful use has caused EMR software to not reach its full potential. I’d even take it a step further and say that meaningful use and its sister EHR certification have done much to level the playing field of EHR software. Instead of doctors choosing an EHR based on usability, recommendations, features, functions, workflow, etc etc etc, they’re asking if the vendor is a certified EHR and can get them EHR incentive money.

A cynical view would be that doctors are now evaluating EHR software based on how easily that EHR software can get them EHR incentive money. While this may be the case for some doctors, my feeling is that it’s not a widespread pandemic problem.

We can all be certain that doctors are evaluating meaningful use as a major component of their EHR selection process. Every EHR vendor I’ve talked to has said this, so it must be true. Since meaningful use is a standard set by the government and certified EHR software requires a certain set of standards, does that mean that in that list of requirements all EHR software are basically equal?

The answer is an emphatic: NO!

I can assure you that some EHR software vendors have slapped in the meaningful use requirements as quick as they could get it in there. I’m sure that some rushed it just to be able to say they were the first. The first to what I don’t know. In many ways, being the first to be a certified EHR with meaningful use baked in could be considered a badge of shame. Instead, if I were a doctor I’d want an EHR vendor that took their time and implemented meaningful use in a thoughtful way that will be as seamless and non-intrusive as possible.

I still love what Conan Fong and Kyna Fong of ElationEMR said to me about meaningful use and EHR certification: We’re trying to strip out the EHR certification and meaningful use requirements as much as possible so that the doctor doesn’t even know she’s doing it. It just happens in the natural flow of her work. [Obviously not an exact quote since it was a couple years ago, but you get the gist.]

Compare that approach to an EHR vendor that just slapped in some features to meet the requirements without much thought of how that will actually impact a doctor. Indeed, not all meaningful use EHR implementations are created equal.

It still gets under my skin a little bit to think that how well an EHR implemented meaningful use becomes part of a physician’s EHR selection criteria. Something doesn’t feel right about that to me. However, I expect that those EHR who thoughtfully approached meaningful use and EHR certification also did the same with everything else in their EHR and so maybe that’s not such a bad thing after all.

Anne Zieger has a really interesting post about Hospital Recommended EHR software over on Hospital EMR and EHR. In it she talks about how most doctors don’t take the hospital recommended EHR software. This will come as little surprise to doctors and likely to hospital systems as well. Doctors and hospitals have always had a mixed bag relationship. There’s this odd co-dependence that usually makes the relationship awkward.

When it comes to EHR adoption, physicians love the idea of getting IT and implementation support from the hospital. They also love the group buying power. Although, they also are concerned that they’ll just be a small fish in the big hospital waters and not get the support that they think they deserve (and maybe they do). Although, the most important reason doctors don’t want to get the hospital recommended EHR is they don’t want to create that “permanent” tie to the hospital. Of course, this is one major reason why hospitals want doctors to take their recommended EHR.

If we can say that doctors don’t trust hospitals recommended EHR software, then who do they trust?

That answer is easy: other doctors.

There’s something really powerful about the trust connection that doctors have between themselves. I’m sure there’s a number of factors that contribute to why they trust doctors more. It probably goes back to the bond that going through medical school creates. Reminds me of when my brother described how boot camp in the Marines created a unique bond between Marines. Doctors seem to experience a similar bond around medical school. Even if they’ve never met before, they can connect sharing “war stories” from their medical school and residency experience.

In many cases, their physician colleagues are a great reference pool for them when it comes to EHR selection. This is particularly true if their colleagues are in the same specialty and have a similar practice size. Although, once doctors start talking to colleagues from different specialties or different size institutions then they often run into trouble. The EHR that works for a 100 office multi-specialty clinic likely won’t be the right one for a solo practice.

IT Service Companies
I also believe many practices have a great trust in their IT service provider. You can see this trend in how many IT service company employees comment and subscribe to this site. Plus, many of them offer some sort of specialized EHR service to doctors. In fact, many are VARs for EHR vendors.

Internet EHR Info
Turns out that most doctors are very independent thinkers. So, many of them want to do the EHR selection on their own. This leads them to the internet to search and narrow down the list of EHR companies. I expect the internet resources for EHR are probably now the most influential part of a physician’s EHR selection process. Can you imagine a physician selecting an EHR without online research? I can’t.

Who else do you see influencing the EHR selection process?

I was reading on LinkedIn the other day, and someone suggested that in far too many ways we’re restricting our view to the following question:

How can I spend less time in a patient encounter?

While this certainly applies to our use of technology in healthcare it goes well beyond just EHR. Although, one challenge with technology like EHR is you get exactly out of it what you design it to do. If the focus of your EHR is just about minimizing the patient encounter, then that’s what you’ll get. If the focus of your EHR is to maximize reimbursement, then that’s what you’ll get. If the focus of your EHR is to meet government requirements, that’s what you’ll get.

Instead, of you focus an EHR on providing amazing patient care, that’s what you’ll get.

Many like to blame the EHR vendors for not producing EHR software that improves patient care. While I think they hold some responsibility, they are mostly just trying to satisfy the demand of their customers.

Healthcare deserves better and we need to find ways to incentivize doctors to want an EHR because it improves patient care. Otherwise, we’ll keep getting great billing engines which minimize the patient encounter at the expense of great health care.

Adam Sharp, MD, Founder of par80 and SERMO, has come out swinging on his relatively new blog for his new company par80. One of his first blog posts talked about why EMR is a four letter word for most doctors. The thing is he’s right in many ways.

The first thing he does is debunk the 50% EHR adoption number that’s gone around and been propagated by the ONC and others:

The 50% adoption rates seen in the first link reflect the presence of ANY type of an EMR-like technology. While it is a great headline for sure, the second link shows that this is an overly broad declaration. When we look at “fully functional systems,” meaning they are being used for a full work-flow solution, we get numbers in the low teens instead. (When you subtract out unique situations such as Kaiser, the VA, and a few large independent doctor networks, I suspect the actual number is much lower.)

I personally put EHR adoption at about 25%, but now we’re quibbling over small percentages. Either way, it’s quite low. Adam describes the real challenge that EHR vendors face and how they can remove the 4 letter word connotation of EMR:

Widespread adoption of an EMR (or multiple compatible EMRs) that is intuitive and easy to use, that empowers the end user and patients, and that actually helps to make the healthcare system more efficient would be a good thing for doctors, patients, and the industry. However, unless we recognize what the ultimate goals are and better involve the people most critical to their effective use (physicians), I believe Jonathan’s prediction will be true and cash-for-clunkers applied to the healthcare sector will turn out about as successful as that other government program…TARP.

I think this trend is changing for many EHR vendors that really are trying to focus on the physician, but sadly have this huge distraction called meaningful use. Plus, we are having more doctors write about their good experience with EHR. The more doctors that can say that their desk is clean, their life is better, and they have more time, the more we’re going to see EHR adoption really increase.

Unfortunately, there’s still far too many poorly implemented, poorly selected and poorly accepted EHR implementations out there. This is a tough problem to solve particularly in this government incentivized environment. I think I read recently in a passing tweet something about HIMSS soliciting for more EHR success stories. I don’t think a manufactured list of EHR success stories is going to do the trick. Although, it’s true that EHR failure stories spread faster than EHR success stories.

What do you think will shift the tide of EHR adoption? Is the EHR incentive money going to be enough to change it? We’ve certainly seen some increase in EHR adoption from the EHR stimulus, but will it be enough and in the right direction?

It’s getting close to a year since I last wrote a post about the companies who support the work we do here at EMR and EHR. Since it has been so long, I thought I’d just list all of the companies that have ads on EMR and EHR and say a few thoughts about each company. I also dug back into my archives and figured out how long they’ve been advertising with me. It’s amazing to see some advertisers going all the way back to 2009.

Practice Fusion – Advertiser since 4/2010 – I had to really dig into my email to see when Practice Fusion first started advertising on EMR and EHR. A name change made it even harder, but I found the original email when Kellie first emailed about Practice Fusion advertising. I imagine most people know about Practice Fusion’s Free EHR. I should ask them how many people have signed up for their EHR from ads on my sites. Considering it’s free, I bet it’s a large number of sign ups. It’s really quite amazing how far Practice Fusion has come in the past few years and I think they’re really just getting started. I love having front row seats to the Free EHR model at work.

Ambir – Advertiser since 1/2010 – I’ve been a fan of Ambir ever since I my clinic had to drop a few thousand dollars on non-Ambir scanners for their office. Sure, for a few thousand dollars the clinic got some great scanners that worked well, but if I’d known about Ambir at the time we could have saved a lot of money. I’m planning to do a full write up of their Ambir ADF scanner. It’s a really sweet product at a much better price point than the other industrial strength scanners out there.

SOAPWare – Advertiser since 7/2010 – Not only has SOAPWare been a long time supporter of EMR and EHR, but they’re also regular readers of my sites and some of the nicest people you’ll meet in this world. I think it’s the southern roots of the company along with their founder, Randall Oates, MD, that guides who they are as a company. If you ever get the chance to sit down and talk with Randall Oates, I can assure you that you won’t be disappointed. He’s been doing EHR software since before it was called EHR software. I think that’s reflected in SOAPWare’s approach to EHR development.

Mitochon – Advertiser since 12/2010 – Founded by Dr. Andre Vovan, Mitochon has a vision around connecting doctors through a Free EHR, Free PM, and Free HIE. In many ways, when I first met Andre Vovan and Mitochon back in 2010 he was already talking about what we now call ACOs. Offering the whole suite of health IT services (EHR, PM, and HIE) for Free is a really interesting way to be able to achieve an ACO and for that matter connected healthcare.

Amazing Charts – Advertiser since 5/2011 – One thing that sets Amazing Charts apart from other EHR software is that it was founded and first created by a physician, Dr. Jonathan Bertman. At HIMSS I had a meeting with Dr. Bertman and at one point he described how Amazing Charts didn’t mind leaving money on the table. I found it a really interesting way to describe their corporate approach to not try and nickel and dime the doctor at every corner. I think this approach is something that doctors really appreciate when their selecting and purchasing an EHR.

Elsevier – Advertiser since 9/2011 – I’m sure many of you have seen the name Elsevier all over healthcare. They are a company with a large footprint in healthcare across a variety of parts. In the case of EMR and EHR, Elsevier is advertising their Gold Standard Drug Database. For those who don’t realize it, EHR vendors don’t create their own drug database (with very few exceptions). Instead, EHR vendors rely on databases like Elsevier’s Gold Standard Drug Database. Turns out this is a much better model. Most EHR vendors would do a terrible job trying to create a drug database themselves.

Medical Mastermind – Advertiser since 1/2012 – Originally started as a practice management system, Medical Mastermind has been working in healthcare since 1984. They take a very hands on approach to supporting their customers and while they’re known for their practice management software, they’ve also added EMR and ePrescribing as well.

Cerner – Advertiser since 9/2011 – Do I really need to go into who Cerner is? Their one of the industry heavy weights in the EHR world. One thing I’ve personally found interesting in my interactions with Cerner was the type of forward looking features they’re discussing. They seem to have taken a really broad look at what EHR will be like 20 or 30 years from now. They’re asking questions like, How are we going to deal with a 50 year patient record? This is probably deserving of its own post, but I was intrigued by their look at EHR software and being able to do things now that will make life better for doctors in the future.

HITR – Advertiser since 1/2012 – HITR is an interesting Healthcare IT community built around research. Brought to us by Porter Research and Billian’s HealthDATA, it’s a really smart idea to bring together those that can provide and want the research data into one place. Those that participate can get financial and quality performance comparison data on peer facilities and a benchmarking tool that can help providers. They can also rank vendor products and see how other providers have ranked those products.

Greenway – Advertiser since 3/2012 – Coming off their successful public offering, Greenway (GWAY) is well positioned to be a big player in the EHR market. Doesn’t hurt that thehave 40,000 healthcare providers in 30 specialties using their products and services. I’m also intrigued by Greenway’s new Marketplace. We’ll see how many leverage Greenway’s API technology on top of PrimeSuite.

Online Tech – Advertiser since 3/2012 – As I recently posted on EMR and HIPAA, Online Tech is a hosting company that takes security and privacy seriously. If you’re looking for a host that can meet the HIPAA guidelines you should take a look at Online Tech. Talk to them and then to other hosting companies and I bet you’ll see a big difference in how they approach the HIPAA requirements.

SequelMed – Advertiser since 11/2009 – I think the Sequelmed home page describes them well: trusted by over 15,000 physicians and over 1,000 practices. I think Sequelmed is one of the many EHR companies out there that’s generally gone along quietly about their business. They aren’t big and flashy, but they keep adding more and more doctors and servicing those doctors they already have on board.

NoMoreClipboard – Advertiser since 2/2012 – I recently called the NoMoreClipboard and iMPak product offering the “most creative technology” I found at HIMSS 2012. I plan to do a full post on the technology at some point as well. Although, I love the approach that NoMoreClipboard and iMPak have taken to be able to get the data to improve healthcare while realizing that many don’t want to have to deal with all the tech details. This is a hard concept for many of us that live and breathe tech to understand and appreciate, but many people want tech solutions that more easily fit into their life flow.

There you have it. I really appreciate each of these companies support. I hope to continue working with these companies many years into the future as we continue covering the crazy world of EHR and healthcare IT.

Earlier this month I wrote a post describing EHR as the Database of Healthcare. I believe this is a powerful and important thing to understand. It also led to some good conversation in the comments. As an entrepreneur I’m always interested to see the trends in the industry to hopefully better understand what is going to happen in the future. I think that this is one of those trends.

Just to make the case clearer, consider the effects of meaningful use on EHR software. Meaningful use stage 1 and EHR certification has already hijacked at least one EHR development cycle and you can be sure that meaningful use stage 2 and stage 3 will be hijacking another couple EHR development cycles. You heard me right. In order to meet the EHR certification and meaningful use requirements, most EHR vendors have to put a whole development team focused just on meeting those government requirements.

Meaningful use has codified EHRs into a box.

Instead of allowing EHR software to create innovative solutions it requires standards be met for storing and accessing info. Sure it also adds in security and tries to work towards interoperability, but those aren’t innovations that doctors want to see.

I expect many of the best healthcare innovators will build on top of the EHR base, not try and build the base again.

A few months back I attended a user group meeting for a large EHR vendor. While waiting for the opening keynote speech I was talking with the EHR vendor’s PR person. During our conversation they made a really interesting comment that stuck with me. I can’t remember the exact context of the conversation, but they said something to the effect of, “We also do a lot of work in revenue cycle management (RCM) and Accountable Care Organizations (ACOs), but that’s not the sexy things that people like to write about even though that’s where a lot of the money is in our business.”

It begs the question, “Is Revenue Cycle Management (RCM) sexy?”

Her comment really has had me thinking about revenue cycle management and particularly her final point about that being where the money is in their business. I’ve always believed in business that it’s a smart thing to follow the money, whether its sexy or not. On that note, I plan to do a series of posts related to revenue cycle management here on EMR and EHR. As for ACOs, I already started a series of ACO posts on EMR and HIPAA starting with my post “ACO Model Risks and Rewards.”

While I might not try and achieve the lofty goal of making revenue cycle management sexy, I do hope to be able to dig into many of the dynamics around revenue cycle management. I hope to look at reasons why revenue cycle management is so popular and doing so well. Why do so many doctors and hospital CIO/CFOs turn to revenue cycle management for their practice and hospitals? Are all RCM options created equal? What separates the various RCM options? What will be the future of revenue cycle management going forward?

In the past week, a number of online discussions have kicked up around a post I did on EMR and HIPAA around Streamlining Revenue Cycle Automation. The discussion shows there’s a real interest in discussing this topic.

I’m also interested to hear your thoughts on revenue cycle management. Are there areas you’d like me to cover? Are there important trends in RCM that more people should know about? No, this isn’t an open invitation for revenue cycle management companies to pitch me. I’m interested in good information about what’s happening with revenue cycle management.

No doubt that managing the revenue of a hospital of physician practice is incredibly important. Hopefully we can add to that knowledge base. Plus, I think it’s likely worth exploring how adoption of EHR is impacting revenue cycle management as well. Will there be less of a need for revenue cycle management with more EHR software or more of a need for RCM?

Let’s hear your thoughts, suggestions and ideas about RCM in the comments. Hopefully I can build on them in future posts.

It’s time again for the next entry in our series of EHR videos called: 5 Questions with EHR Vendor executives at HIMSS 2012. In this video I ask the 5 questions to Rohit Nayak, VP of Physician Tech Solutions at Quest Diagnostics (makers of the Care360 EHR).

My apologies to Rohit for mispronouncing his name in the intro. I appreciate his good nature and pronouncing it correctly. I don’t think I’ll ever forget the name Rohit again. I appreciate him taking the time to answer the 5 questions.

Be sure to check out all of the 5 Questions with EHR Vendor Executives at HIMSS 2012 videos.

It’s time again for the next entry in our series of EHR videos called: 5 Questions with EHR Vendor executives at HIMSS 2012. In this video I ask the 5 questions to Eric Sorenson, VP of Marketing at ChartLogic.

My apologies to Eric for the lights being dimmed during the video and the loud speaker on the vendor floor coming on during the video. I guess the show floor isn’t the best place for video when it’s about to close down. Regardless of the distractions, Eric was a real professional and kept providing us good information about ChartLogic EHR.

Be sure to check out all of the 5 Questions with EHR Vendor Executives at HIMSS 2012 videos.