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An EHR role for IPAs


By offering discounts, subsidies, and ongoing support, these groups aim to help members go paperless.

As capitation has receded, fewer and fewer IPAs have been able to bargain with health plans, because antitrust law prohibits IPAs from negotiating fee-for-service contracts on behalf of physicians. As a result, IPAs are increasingly seen as paper tigers.

Becoming electronic tigers, however, may provide the formula for converting numbers into true strength. By helping doctors convert to electronic health records, IPAs can pave the way for clinical integration of physician offices. If they do that, the government might let them collectively negotiate fees with plans.

And by making it easier to switch from paper to electronic charts, IPAs can also position doctors to participate in pay-for-performance programs, which reward physicians who can demonstrate that they're taking good care of patients.

"Giving doctors these electronic tools is the next big thing for IPAs," says Albert Holloway, president and CEO of The IPA Association of America. "It will rejuvenate them."

Several IPAs are so serious about promoting EHRs that they're giving doctors sizable grants to defray the costs of going paperless. That's on top of discounts negotiated with vendors. Some IPAs also promise to provide IT support, which will make it easier for physicians to operate their new gizmos.

All these efforts are in the infancy stage, and whether they make it to adulthood depends on the wisdom of the various strategies. IPAs that offer only one EHR brand to their members, for example, risk displeasing doctors who'd prefer another program, perhaps because it better reflects their specialty. "One size may not fit all," says FP David Kibbe, director of the Center for Health Information Technology at the American Academy of Family Physicians.

That said, IPAs that risk nothing stand to gain nothing. If you belong to an IPA, and want it to become an electronic tiger, you can learn some lessons from the enterprising IPAs we've profiled here.

An EHR helps this IPA at the bargaining table Brown & Toland Medical Group, a 1,500-physician IPA in the San Francisco area, has made a big bet on EHRs. It intends to spend $12 million over 10 years to help its doctors go paperless.

The centerpiece of the system is a Web-based EHR called TouchWorks from Allscripts Healthcare Solutions. Last November, four of the IPA's community-based physicians began using a TouchWorks module that lets them access test results from patients' labs in real time. As of March, almost half of the community-based doctors had signed up for this tool (another 800 Brown & Toland physicians at the University of California, San Francisco, rely on another EHR program). By the end of 2005, the IPA hopes to have 25 physicians using the full EHR program. "We want to go slow at first to make sure the system works well and that we're providing the necessary support," says Nancy Griest, vice president of medical group services for the IPA.

Brown & Toland buys Touch-Works licenses and resells them below what individual doctors would pay, says Griest. As a result, a solo doctor can get the EHR-with implementation, training, and support included- for roughly $400 a month. Larger practices pay less on a per-physician basis. Doctors can also buy hardware at discounted rates that the IPA has wrangled with vendors. The fact that the EHR program is Web-based minimizes the hardware investment because doctors don't need to buy an expensive server to host the software.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health