personal health record

A Virtual Accountable Care Organization (ACO) and the link to Pediatric Practices

September 5, 2012 in Uncategorized by support Team  |  2 Comments

With Healthcare costs increasing at a rapid rate in the United States, there are a number of payment models being investigated that look to encourage preventative care while reducing costs. Although most practices generate the majority of their revenue from Fee for Service insurance products, there is much talk as well as movement related to Accountable Care Organizations (ACOs). The concept of ACOs is that an organization manages a large group of providers and hospital systems to provide patient care. The ACO and the providers would be compensated for management of a population. The leaders in this field are exploring many different methods for payment – a set fee per patient for all care, bundled payment per episode of care as well as other risk sharing arrangements. ACOs are most thought about as hospital systems that purchased provider groups (e.g. Integrated Delivery Systems) and form an ACO entity. In this case, the Pediatric Group would need to be owned by the hospital system to participate in the ACO.

Although the Medicare Shared Savings Program ACO sponsored by the Centers for Medicare and Medicaid Services (CMS) has the most publicity, the commercial payers are beginning to experiment with ACO payment models as well. The Medicare Shared Savings Program ACO shares the savings of ACO effort between the ACO and CMS (the providers continue to receive Fee for Service payments at this time).

There is another type of ACO model known as the Virtual ACO or community ACO. This model would be an organization that is the contracting agent with payers and would like to privately owned practices. For example, ABC Pediatrics (privately own), could participate in a virtual ACO without selling their practice. The virtual ACO would develop the guidelines on how to participate as well as the payment stream. There is much question as to how this will impact Pediatrics. The good news is that private practices should not be required to sell their practices as the ACO model evolves.

Practices and practice managers should continue to keep an eye on the payment methods in the field. Improper coding as well as low collection rate continues to be a very common issue with Practices that if managed appropriately, optimize the revenue to the practice. In Pediatrics, this requires a team that receives routing training in Pediatric coding, systems that gain intelligence as payers change reimbursement policies and consistently reporting and follow-up. So although there is much talk and experimentation with new payment models, most practices need to look how to appropriately manage the revenue cycle in today’s payment system.

The Cost of Maintaining a Server in a Pediatric Practice

July 2, 2012 in Uncategorized by support Team  |  Comments Off on The Cost of Maintaining a Server in a Pediatric Practice

I enjoy speaking with customers, potential customers, vendors and suppliers to obtain feedback as well as perspective. Recently, I was made aware of the actual costs that a practice incurs for appropriately maintaining a server. The ‘old’ method of establishing Electronic Health Records in an office was to install and operate a server with an internal network. Although this is still an option today, there are many expenses such as initial and continued operating costs that cloud computing provides a better choice. The winners of practices that choose client-server E.H.R. Systems are server companies, software companies that supply software for client-server applications and technology/server consultants that maintain servers.

I continue to be made aware by physicians of the cost of operating a server. The range in cost really concerns me and surprises me. For example, I know of a one-physician practice that was spending over $700/month just on an IT consultant to maintain his servers/network. When the Internet was ‘dial-up’ there was not another option for a physician practice. Businesses of all sizes began moving from client-server applications to cloud-based applications for many reasons. Some of these reasons include: most up to date software, lower operating costs and easier establishment of additional computers/users.

Evaluate the total cost of the option when deciding to choose client-server vs. cloud computing. Here are some items to obtain cost ranges when comparing a cloud-based option to a client server option:
-Cost of the servers, network gear and estimates of how often this equipment needs to be replaced.
-Cost of installing the network
-Cost of maintaining optimal up time of the network as well as maintenance
-Cost of software for the server (initial and yearly cost).

Consider conducting some ‘basic’ research by calling a local IT consultant to obtain a price quote. Also remember that you or an office manager will need to be the project manager/coordinator of the people and vendors once the practice decides to choose either cloud-based application or a server-based application. With a cloud-based application, the practice will need to maintain an internet connection as well as a wireless network. If there is not a person in the office whom is comfortable setting up a wireless network, usually a lower cost group such as the Geek Squad can set this up for the office. With a client-server application, the office will need to purchase servers, network gear, software for servers (in addition to their E.H.R. software) as well as incur an expert to install the system and maintain the system. The practice will also need to install battery back-up and a maintenance plan with all the components. These are examples of some of the hardware maintenance costs of a server.

There are many articles on the economic benefits of cloud-computing. For instance, see the April 30, 2012 article in Forbes Magazine titled “Cloud Could Cut $12 Billion from US Government Annual Deficit”. The study quoted in this article states that the US Government could reduce the annual IT Spend from about $80 B to $68 B. The winner would be the cloud-computing companies while other groups would either lose their contract or have reduction in services. Do not under estimate the amount of lobbying, PR and Marketing that the groups impacted by this migration to cloud computing will exhibit. Remember, the practice is ‘on the hook’ for the short term and long-term cost of a decision of client-server vs. cloud computing (not an external consultant whom might have minimal to no experience optimizing revenue for a practice). Internet speeds continue to increase dramatically which further enhances the positive aspects of cloud-computing.