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Practice Management Systems for Community Health Centers

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SHOULD WE IMPLEMENT MULTIPLE SYSTEMS AT ONCE, OR DO THEM ONE AT A TIME? ... Why should we bother going through the Request for Proposals (RFP) process? – PowerPoint PPT presentation

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Title: Practice Management Systems for Community Health Centers


1
Practice Management Systems for Community Health
Centers
  • Presented by
  • Diane Gaddis
  • Steven D. Weinman
  • August 2008

2
Session Description
  • This presentation will cover the basics of what
    constitutes a PMS system, and will provide
    practical advice on how to identify, evaluate and
    choose a suitable PMS system for a typical CHC.
    It will include lessons learned by the
    presenters, who between them have produced,
    chosen and successfully implemented such systems
    in a CHC environment.

3
  • Diane Gaddis currently serves as CEO President
    of Community Health Centers Alliance, Inc.
    (CHCA), based in St. Petersburg, Florida. Diane
    has more than thirteen years experience in the
    Community Health Center environment, which has
    included executive, information systems, and
    financial management roles. CHCA provides
    acquisition services, project management,
    implementation coordination, training,
    application support, and system management
    services related to practice management systems
    and electronic health records to CHC members in
    Florida. 
  • Steve Weinman is currently the Executive
    Vice-President and COO of Collier Health
    Services, Inc. (CHS), a large CHC serving Collier
    County in SW Florida. Steve has been with CHS for
    24 years starting as IT Director and moving up to
    CFO before being promoted into is current
    position. He has designed and implemented an
    extensive CHC practice management system which
    was in use for 14 years. Over the years Steve has
    been CEO of a new start CHC, as well as the
    founding CEO of CHCA.

4
The Basics
  • Section 1

5
What is a Practice Management System (PMS)?
  • PMS is a category of software that deals with the
    day-to-day operations of a medical practice.
  • Generally consists of several functions or
    modules, integrated into a single system.

6
PMS Components
  • Appointment scheduling-a calendaring or
    scheduling component that allows staff to create
    and track upcoming patients visits.
  • Patient Demographics-Captures basic patient data,
    as well as insurance and other information
    required to process and bill for visits, as well
    as to produce management reports.

7
PMS Components, continued
  • Charge, Payment and Adjustment entry-allows
    tracking and billing of patient visits, as well
    as keeping account balances correctly.
  • Accounts Receivable Management-Utilizes
    demographic and billing data to manage patient
    and 3rd party balances.
  • Electronic Claims Processing-Allows submission of
    billings without production of paper bills.

8
Some important additional features
  • Sliding Fee Scale calculation
  • Insurance eligibility verification
  • Credit card transaction processing posting
  • Managed care contract posting an reporting
  • Relative Value Unit (RVU) utilization and
    reporting

9
How does a PMS fit together with other Health
Information Technology (HIT) systems?
  • Foundational- must have a solid system to ensure
    smooth front line operations and revenue cycle
    management to fund operations and expansion into
    other areas.
  • HL7- should be able to connect or interface to
    other systems without excessive reprogramming.
  • Consider all systems you might want to use
    currently or in the future-accounting,
    eligibility, credit card processing,
    clearinghouses, Electronic Health Record (EHR)
    etc.

10
Should we choose a PMS first, and then an
Electronic Health Record (EHR)?
  • If a new start doing both at the same time,
    with the right team and support mechanisms, is
    best.
  • For existing project, how adequate is the current
    system? What is the business driver for change?
  • Dependent upon funding availability grant for
    software? Cash from Operations?

11
Should we implement multiple systems at once, or
do them one at a time?
  • Easier done at a new project where patient
    volumes are low.
  • Depends on how much organization can afford to
    spend.
  • If organization is already operational we dont
    recommend implementing both at the same time as
    the impact on the organization will be enormous.

12
Must we get all of our systems from the same
vendor?
  • Potential Pros
  • Single point of contact
  • Cross over accountability
  • Systems should play nicely together
  • Potential Cons
  • May be weaknesses in one functional area
  • If vendor has problems, both sides of the house
    can be adversely affected

13
Marrying best of breed 2 Vendors
  • Potential Pros
  • Quality products for both areas
  • Quality support
  • Potential Cons
  • Interface issues in making systems work together
  • Finger pointing between vendors
  • Additional costs in developing and testing
    interfaces between products

14
Should we do it alone, or partner with a network
  • Pros of doing it alone
  • CHC is the sole decision-maker
  • Needs of the individual CHC always come first
  • Cons of doing it alone
  • All infrastructure costs (production server,
    redundancy, data lines) born by CHC alone
  • Required depth of staffing and diversity of
    skillsets born by CHC alone
  • No benefit of other expertise and collaboration

15
  • Cons of doing it alone, (continued)
  • Costs of implementation (project management,
    training, go-live support) born by CHC alone

16
Pros of the Network Model
  • Pooled financial resources enable the hiring of
    high quality staff
  • Working together enables the hiring of depth
  • Two heads are better than one typically, setup
    and implementation higher quality and more
    successful
  • Cost sharing will allow for server redundancy,
    disaster recovery and other more robust solutions

17
Cons of the Network Model
  • Collaboration takes time and effort
  • Lots of communication is needed between partners
  • Working together requires compromises be made
    between partners

18
Another optionUse Network as a Vendor
  • Benefit from network CHC specific expertise and
    alignment with CHC mission
  • Network is in more of a consultative roles
  • May be more costly than the collaborative model

19
What is ROI, and why is it important to consider
when making a decision?
  • Return on Investment If there is no value, why
    do it?
  • Tangible costs vs intangible costs
  • Factoring in acquisition and implementation costs
  • Personnel savings and resource shifts
  • Defining recurring costs
  • Quality improvement and market readiness
    intangibles to factor in

20
Process of choosing a pms
  • Section 2

21
What players should be involved?
  • Should the process be driven by the IT
    department?
  • IT support for the business departments and
    functions
  • IT infrastructure, communications, desktops
  • Who should manage the project?
  • Experienced project management poor project
    management can increase costs
  • Business leaders financial and operations
    management

22
What other staff should be involved, and what are
their roles?
  • Finance must, in advance, determine reporting
    needs and evaluate product. Must also understand
    the basics of a PMS how to evaluate the
    products management of transactions and impact
    to financials
  • Operations must, in advance, determine current
    and future operational, appointment, and patient
    flow management needs to evaluate product

23
Other Staff - continued
  • Billing experienced CHC billing personnel
    familiar with state Medicaid and other CHC
    specific billing needs
  • IT experienced in latest technologies but with
    an understanding of CHC constraints

24
Which systems should we look at?
  • Can any Medical practice management system work
    in a CHC environment?
  • No - In addition to the basics that every good
    ambulatory healthcare office needs, CHCs require
    products more robust and that can meet FQHC
    requirements
  • Product must be able to support the varied
    service offerings of a CHC (ie primary care,
    ob/gyn, dental, behavioral health).

25
What feature set is important for a CHC to
consider?
  • UDS data capture and reporting
  • Sliding Fee for different service groupings
  • Auto adjustments for FQHC reimbursement rates
  • Splitter at charge entry
  • Ability to write custom, flexible reports

26
Why should we bother going through the Request
for Proposals (RFP) process?
  • Dog n Pony shows do not ensure quality just
    good vendor sales pitches
  • RFP response can become part of a contract
  • Ensures a more apples-to-apples comparative
  • Protects CEO and Board demonstrates due
    diligence

27
How do we develop the RFP?
  • Requires experience and keen understanding of
    environment
  • Legal input is recommended
  • Evaluate the vendor and reputation in addition to
    the product
  • Use HRSA document as a resource for functional
    requirements baseline

28
How should we evaluate the RFP responses?
  • Create a scoring tool which of the functional
    requirements are required vs optional?
  • Use of a scoring tool weighting the required
    items
  • Document, document, document questions and
    answer exchange

29
The vendor wants to come do a demo-what should we
do?
  • Allow free form demos first
  • Follow up with controlled demos
  • Dont be afraid to make them demo again and
    again.
  • Understand that demos can have value, but they
    are designed solely to make the product look good
    and weaknesses will not be addressed.

30
Once we choose the product we want, how do we
negotiate with the vendor?
  • Understand their various licensing models
    available
  • Understand your needs and how they much the
    licensing model
  • Pay the money as deliverables are met, not all up
    front
  • It pays to contract with a competent resource to
    assist in this process.

31
How do we develop an ironclad contract to protect
our organization?
  • Read the contract thoroughly, understand the
    various licensing options
  • Use a competent attorney experienced in software
    contracts
  • Use a competent resource to advocate for your
    needs and help with the review process
  • Dont scrimp on expertise here or it will cost
    you in the long run

32
Questions
  • Contact Information
  • Diane Gaddis
  • diane_at_chcalliance.org
  • Steven D. Weinman
  • sdweinman_at_yahoo.com
  • April 2008
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