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New tools can help grow or run a practice, but be sure they also help the bottom line
Physicians often succumb to the allure of costly IT products that don’t work with existing systems or that stretch the budget when a lower-tech alternative would work just as well, says John Levinson, MD, Ph.D., a Boston internist and cardiologist with AllCare Medical. Federal mandates that spurred huge spending on electronic health records (EHRs), for example, have been the equivalent of government requiring people to buy cars before gas stations were built, he says.
More than ever, physicians must scrutinize their technology budgets and pare unnecessary cost, putting in the time to find not only the best tech products for their practices, but the best ways to acquire them, Levinson says.
“You have to ask really hard questions of vendors who want to sell and lease you things, because often there are less expensive alternatives with fewer bells and whistles,” he says.
Among the key questions to ask before purchasing technology, experts say, are:
Practices need to consider how much time any new technology will require from physicians and staff to implement, and balance that with any promised time savings, says Jack Stockert, MD, MBA, managing director of business development for Health2047, a company that develops and funds healthcare startups.
“I’ve seen a lot of waste and ill-advised spending because practices haven’t contemplated how a technology will fit in with the overall workflow” and make daily tasks simpler, Stockert says.
Along the same lines, physicians should think about low-tech ways to access tech upgrades, suggests Elizabeth Woodcock, MBA, FACMPE, an Atlanta-based speaker and trainer who focuses on practice and revenue cycle management.
For example, physicians don’t always ask hospitals to connect to their practices electronically, then the practices lose staff time in getting records faxed to the office and entered into the practice records system, Woodcock says. Often, so much time elapses that billing for transitional care after discharge is impossible, she says.
“A lot of times practices are waiting to hear from the patients themselves what’s going on in the hospital, when they should be saying to the hospital that they need a daily information feed on what’s happening,” she says, particularly as more practices consider adopting the patient-centered medical home model.
Another relatively low-cost way to keep up with technology is to protect what the practice already has, to avoid having to buy new equipment in the first place, says Ira Parghi, LLB, MPP, counsel in healthcare law and an information security committee member at Ropes and Gray in San Francisco.
“A big area of focus is this whole area of patch management, making sure your existing programs are getting regularly released patches, or security upgrades,” Parghi says. Appoint someone to make sure auto-updates are turned on, she says.
If a new software program will require a substantial change in the daily duties of staff members, consider whether they have the right skills to make it work, he says.
It might also make more sense to improve overall operational efficiencies in the practice before adding new IT systems, Stockert says.
Because unhappiness with EHRs is so widespread, Stockert recommends that practices wait for next-generation products that are designed to improve practice operations, rather than making a change now to a similar EHR out of frustration.
In other words, he says, don’t dump a system before knowing a replacement is in the offing that is better. Ask vendors about the capabilities of any new system and request demonstrations to show how it will improve the way a task is completed or how it improves practice workflow.
Depending on the life cycle of a product under discussion, leasing might be a better option than purchasing, experts say. Practices starting a telemedicine service, for example, can dramatically reduce startup costs by leasing the equipment, says Nick Hernandez, MBA, FACHE, chief executive at ABISA, a Valrico, Florida, healthcare consulting firm.
“A lot of practices are looking at doing things over the cloud using subscription services, particularly telemedicine,” he says. They are scaling down their hardware and outsourcing whenever possible, which cuts down on acquisition and, over time, maintenance costs.
“For practices just sticking their toes into a new area, it makes a lot of sense,” he says.
Beyond EHR system demands, healthcare reform is beginning to reach into interoperability and cybersecurity, Stockert says.
As patients’ rights to their own health information expand, small and mid-sized practices could be particularly squeezed as they attempt to provide on-demand information, he says.
When thinking ahead, consider the overall strategy for technology in the office, says Hernandez. He recommends practices craft a three- to five-year capital plan for technology purchases, from bigger-ticket diagnostic equipment to mobile phones and tablets.
Each year, designate one area to receive an upgrade. This way, practices are staying current, and spreading depreciation and capital outlays over several years for tax-planning purposes.
After a few high-profile ransomware attacks this year, data security expert Jonathan Fairtlough, JD, has been warning physicians not to buy expensive data security systems that doesn’t actually keep them safer.
Some of these are designed for much larger practices and take a lot of staff time and money to use, says Fairtlough, a managing director in the Los Angeles office of the cybersecurity and investigations practice at security firm Kroll.
He suggests going through regional buying groups to create a request for proposals that can cost-effectively address security issues for several practices at once. This can also elicit information about what other practices are budgeting for these expenses.
Aside from data security, the same question is relevant to technology generally. Am I buying what amounts to unnecessary added features when a lower-cost solution will do?
While a $30,000 waiting-room kiosk that lets patients fill out their own medical history forms looks impressive, a free online form that patients can download at home before the appointment gets the job done, Woodcock says.
“Physicians would need to encrypt the form, which will cost some money,” she says, but there are low-cost encryption techniques that would cost a fraction of what the kiosks charge.
Practices without enough staff to handle these types of tasks might consider creating a practice internship with a local community college or university that will establish a pipeline of computer-major interns who work for experience rather than pay, she says.
Reaching out to colleagues in similar practices can help illuminate ways to buy smarter, says M. Christine Stock, MD, an anesthesiologist in Chicago.
Likewise, letting vendors know precisely what isn’t working with a given product is important for getting the most cost-effective tech products in place, she says.
Having overseen an intensive effort to customize an EHR system while she was department chair at a large academic center, she continues to prod tech vendors to explain how a proposed product will improve care quality or the ability to process the enormous amount of data being generated in medicine today.
Finally, experts warn physicians to curb their enthusiasm.
Don’t expect to see miraculous results from all the spending on technology, notes Alan Plummer, MD, vice president of the Physicians Foundation.
“Everybody wants a perfect system and so far nobody has designed that,” he says.
Asking detailed questions about system capabilities that apply to a specific practice is the best way to avoid costly mistakes, he says, but the systems have a long way to go to win physicians’ approval.