The reason I chose to share this story is my belief that it is de rigueur among practitioners. I have been spending some of my time working on behalf of a small clinic. Four doctors, two offices, small lab, x-rays, some surgeries.
Great people, great mission. Every physician spends several weeks each year doing unpaid missionary work in Africa and South America. Their focus is caring, not dollars. It is not my job to change their focus. They do not turn away anyone who cannot pay. Staff at the front desk help patients pay for their meds. The four physicians routinely offer services and perform procedures for which they know they will not be paid. I feel a real sense of pride helping them, and have slashed my rates to make sure they get the help they need without taking money unnecessarily from their coffers. Their patients love them, and they add about a hundred new patients a month.
The business side of their practice could have been designed by Rube Goldberg. As I interview the doctors, the nurses, the lab, and the front desk about the practice, I try to do so with a straight face, try not to betray the part of me that wants to say, “You’re kidding, right?”
They meet with about fourteen-hundred pharmaceutical reps each year. I tried to pin down why they do it, but could not come up with an answer to support a business reason. Since the pharma reps can no longer offer trinkets equivalent to those needed to purchase Manhattan, they give away lunch. Enough lunches to ensure that everyone in the practice should weigh eight-hundred pounds.
They use the F-word a lot—faxes. Two fax machines running often enough that without proper cooling they would melt through the floor. The average fax is handled eight times before it is placed in the patient’s chart.
There is no email, no web site. There is no triage—docs and nurses do not screen patient phone calls to determine who needs to be seen. Seventy-five patients a day, two and a half people are full time on billing. Three people man—actually, it should be “woman”, the front desk. (Is that an intransitive verb, or simply poor writing on my part?) The staff wants more staff.
I have been hired to help them with the selection and implementation of their EHR. I can solve the EHR problem in five minutes, but I won’t. Having an EHR will solve none of their problems, at least not until they turn what they do into a business.
Realigning their business processes will do more for their mission than any EHR. Processes are inefficient and ineffective. I cannot figure out how they collect money or pay bills.
I am willing to bet they are not alone in having these issues. I’d bet that these problems can be extrapolated to hospitals. Is Practice Management more important to physicians than EHR? My guess is that the right answer is yes.
Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy
1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
Thank you foe writing this, Paul.
I don’t know much about hospitals, but what you describe is how most small clinics operate. Practice Management is indeed more important than EHR. Practice Management is actually a prerequisite to EHR, because there’s no point fooling around with an EHR if you are going to go bankrupt in the very near future. I cringe every time people criticize EHRs for being “designed for billing”. They better be designed for billing because before you can exchange SNOMED encoded CCD, you have to meet payroll. You can run a practice without HIE connectivity, but you cannot run one without payroll.
Doctors like these clients of yours are why I am in this business. Someone has to help them survive in this jungle so they can keep on practicing medicine the right way. I am grateful that you are there for them.
thank you for reading and commenting. I have been consulting for 30 years and have never before seen an industry with such a lack of understanding of the business issues they face or a willingness to confront them
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