10 Medical Practice Management Systems For 2014
For a medical practice, EHR may be important -- but practice management is essential.
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Practice management and electronic health record (EHR) systems are increasingly intertwined and often packaged together, but there is one big distinction between them: While many medical practices adopted EHR in search of government incentives, they adopted practice management software for their own purposes. This is the software they use to run their business -- scheduling appointments, registering patients, submitting claims, and getting paid.
Practice management may not be sexy, but we couldn't help noticing our last roundup of medical practice management products remains one of InformationWeek Healthcare's most popular features, two years after it was published, and outpacing many articles on EHR and other newfangled healthcare software.
Ideally, EHR and practice management systems work together so that patient registrations become patient health records, and the diagnosis recorded into the EHR turns into a properly coded insurance claim. Increasingly, they are modules within a software suite rather than independent products. Practices that are in the market for a new suite may start out thinking about EHR, given the regulatory push and other changes in the market, but the strength of the underlying business system often makes or breaks the suite. Where practices are looking to switch systems, the change is as likely to be motivated by the weakness of the practice management functionality accompanying the EHR as it is by the EHR functionality per se.
The nature of practice management is also changing, given that Medicare and private payers are trying to shift away from pay-per-procedure billing to paying for "value," meaning incentives for providing better care efficiently. Just how complete that shift will be remains to be seen, but it means providers must gather and track different metrics and bill according to novel formulas. At the same time, the proliferation of high-deductible insurance plans, like those commonly offered through Obamacare health insurance exchanges, means that consumers are responsible for a bigger share of the healthcare bill. That means practice management must put a bigger emphasis on consumer collections, which used to be a relatively minor portion of a healthcare business compared with insurance claims processing.
This report is based in part on the Best in KLAS ratings from KLAS Research, which reflect customer satisfaction with health IT products as measured by a survey of healthcare organizations. KLAS segments its findings based on the size of practices participating in the survey, specifically the number of physicians in the practice. There is some overlap with the adjacent category of revenue cycle management, which is the process of tracking insurance claims and resubmitting and tweaking them until they get paid. Practices that don't want the hassle can outsource all or part of that process.
Athenahealth's AthenaCollector is the top-ranked product in all but the 75+ physician segment, where it does not yet have enough market presence to register in the KLAS survey. Athenahealth offers a cloud software suite bundled with an outsourced revenue cycle management service, making the software the front end to a business service that handles many of the complexities of claims coding, submission, and follow-up until payment.
Epic, the dominant enterprise system for hospitals, mirrors that performance by ranking No. 1 for practices with more than 75 physicians and not ranking at all below that level.
The table below shows the KLAS rankings for the leading vendors in practice management, some of whom compete with more than one product in the category.
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On the following pages, we present more detail about the distinguishing characteristics of leading practice management systems, with an emphasis on those that serve midsized to large practices. We've also included a couple of choices from the ranks of up-and-coming and niche vendors. Another good tool for sorting through the choices is theĀ Practice Management Toolkit created by the American Medical Association and the Medical Group Management Association.
(Image: Mashup of images fromĀ Pixabay.)
Epic has become the default system of choice for hospitals, particularly larger hospitals. As a system designed for large enterprises, it is not even an option for small medical practices. Instead, its practice management features cater to the ambulatory care units of hospitals. Some hospitals also encourage their affiliated physicians to use Epic as their electronic health record and practice management system, hosting the software on their behalf to minimize the IT burden. That simplifies the coordination of care (and billing) compared with using healthcare information exchange middleware to exchange clinical and business data.
While customers may choose Epic as much for its reputation and the breadth of its suite as for any single piece of software, the KLAS rating shows they are also happy with the practice management functionality, which actually reflects the performance of multiple products: Resolute, Prelude, and Cadence Ambulatory.
While most practice management software vendors offer some version of their product as a cloud service, Athenahealth is the one most insistent on sticking exclusively to a cloud model. Just as significantly, the AthenaCollector software is inextricably linked to the company's business services -- you can't buy the software per se, instead you contract to use it in exchange for a percentage of the money collected through the system. The software serves as the front end to the backend services; the people Athenahealth employs to assist with claims processing and collection use the same software as Athena customers, making it easier for them to speak the same language about claims status.
The "Days In Accounts Receivable" report (above) lets a practice see which accounts are most delinquent. Practices can also add notes based on their own experience with particular payers, as shown below.
Arguably, the KLAS rating (No. 1 for practices of fewer than 75 physicians) could be deceptive in that Athenahealth was graded on a turnkey package of software and service, whereas most of its competitors were graded on software alone. Many of them have also introduced revenue cycle management services to complement their practice management software but have only a fraction of their customers using that combination.
Like other practice management vendors, Athenahealth is also pushing the boundaries of what its software can do with minimal human intervention, automating the selection and submission of insurance codes that, as often as possible, will win approval from payers on the first try. The cloud model helps Athenahealth perfect its model of what gets claims paid and why, as well as other issues affecting a practice's performance such as patient scheduling, according to Jasmine Gee, director of product marketing.
"There is one version of our software that every one of our 52,000 clients uses," she says. "We can see where in the workflow people are getting hung up, or how long it takes someone to get checked in or checked out for a visit."
Ranking in the KLAS survey as one of the top practice management systems for practices of all sizes, eClinicalWorks is second only to Epic for practices with more than 75 physicians. Above is a sample month-end report from eClinicalWorks, which says its clients currently experience a 98% first-pass acceptance rate (claims paid on first submission).
CEO Girish Navani says having "a rulebase smart enough to prevent denials before they occur" is the single most important distinguishing factor for a practice management system. "If the technology does the work for you, you don't have to outsource your billing." Still, eClinicalWorks has started to offer its own revenue management service in addition to partnering with other companies that specialize in that field.
"People now look at EHR and practice management as one system, rather than two," he says, but the practice management side is what pays the bills.
In an interview, he mentioned the importance of efficient patient check-in and check-out and convenient visit reminders. Practices are also looking to enable consumer-oriented features, such as support for self-service kiosks in a doctor's office, where a patient can check in, validate insurance, and pay a copay with a debit card. Online bill payment is also an increasingly important feature.
While knowing how to deal with insurers remains essential, high-deductible plans are making consumer payments a more important part of the puzzle. Accepting credit card payments and billing patients individually "are a bigger part of every practice than they were 20 years ago," Navani told us.
NextGen Healthcare is another of the top-ranked practice management systems in the KLAS survey across practices of all sizes. A subsidiary of Quality Systems, NextGen also offers a revenue cycle management service, although so far fewer than 5% of customers take advantage of it, says Michael Lovett, executive VP and general manager for NextGen. "Most of our installations are standalone, with the practices doing their own work." Through automation of claims processing, NextGen aims to provide "the third shift you don't have to pay for."
The screenshot above is a dashboard view of an organization's key performance indicators, including a summary of appointments, accounts receivables, patient correspondence, statements, claims, and task tracking. That at-a-glance view and the software's ability to track the work that needs to be done to process claims and secure payments are among NextGen's strongest features, notes Lovett. While often overshadowed by EHR hype, practice management "is really the core of the system," he says.
McKesson shows up in the KLAS rankings for two products, Practice Plus, one of the favorites for practices of 75 or more doctors, and Practice Partner for smaller practices. The image above is from Practice Plus.
"A smaller practice needs the same basic solution as the large practices, but those that are larger have to deal with more complexities of financial reporting and how providers are paid," says Jim Reynolds, an executive director at McKesson. The processes a practice must manage start with basics like scheduling appointments and registering patients, then progress through claims processing and billing. Often, larger practices are deeply connected with hospital systems, making coordination of scheduling and billing with the hospital an important element.
Reynolds says McKesson's products are distinguished by their ability "to adapt to individual locations, so it's not cookie cutter," and adjust software workflow to the way a practice functions.
KLAS survey participants in practices with 75 or more physicians gave strong ratings to the ambulatory functions of GE Healthcare Centricity Business (ranked No. 5), which is targeted at hospitals with affiliated practices, while those in smaller practices put their confidence in the GE Centricity Practice Solution (pictured above).
The Practice Solution is offered as a suite, with its practice management module promising effective scheduling (with a customizable calendar for each user), a dashboard for financial management, and tools for dealing with claims denials and reimbursement discrepancies.
Greenway PrimeSuite is promoted as an integrated EHR and practice management suite, offered with the option of integration into the PrimeRCM revenue cycle management service for those practices that don't want to manage their own claims and billing.
The PrimeSuite dashboard (pictured above) provides a snapshot of a practice's performance.
As the result of the acquisition of Vitera, Greenway also offers Greenway Medical Intergy PM, ranked No. 5 in the KLAS survey for practices with 11-75 physicians and No. 13 for those with 1-10 physicians.
Allscripts points to the real-time claims code scrubbing feature of its software (pictured above) as one of its most important distinguishing features, helping practices catch any errors or omissions up front so payers can process claims efficiently and correctly.
The whole front-end process of validating patient insurance and creditworthiness is becoming increasingly important as patients begin to pay a larger share of medical bills, says John Beck, VP of revenue cycle solutions at Allscripts. "That's where the most interesting battles are being fought and won today."
As the economics of healthcare change, it will be more important for practices to collect money from patients up front, or at least inform them of what charges they will be liable for when procedures are not fully covered by insurance, he says, so winning new practice management clients means addressing those requirements.
While not ranked among the Best in KLAS practice management solutions, CareCloud offers an up-and-coming cloud EHR and practice management suite often compared with Athenahealth's cloud service. The product of a younger, Miami-based company, CareCloud is similarly cloud-centric with no on-premises version available. However, one way it differs from the Athenahealth model is in the connection with its revenue cycle management service, which is optional rather than mandatory.
In other words, CareCloud offers a solution for those who want the simplicity of cloud software for their practice management without necessarily wanting to outsource medical billing. CareCloud says the demand for this combination is shown by the fact that only a minority of the customers for its software opt to contract for its revenue cycle management service as well.
Just as there are EHRs specific to medical specialties, there are practice management systems for alternate business models. DocuTAP offers a practice management system specific to acute care (or "walk-in" retail) clinics, which don't conform to the generic scheduling process of a typical doctor's office.
Instead, a network of acute-care clinics takes patients as they come, adjusting staffing to meet demand. One of the ways that translates into software: DocuTAP's real-time monitoring of wait times across multiple locations allows managers to reassign staff from one clinic to another as needed.
DocuTAP does wind up competing against some of the other practice management systems mentioned in this report, says CEO Eric McDonald. "But we can easily win against guys whose products were designed to work OK for everyone rather than designed specifically for urgent care."
Just as there are EHRs specific to medical specialties, there are practice management systems for alternate business models. DocuTAP offers a practice management system specific to acute care (or "walk-in" retail) clinics, which don't conform to the generic scheduling process of a typical doctor's office.
Instead, a network of acute-care clinics takes patients as they come, adjusting staffing to meet demand. One of the ways that translates into software: DocuTAP's real-time monitoring of wait times across multiple locations allows managers to reassign staff from one clinic to another as needed.
DocuTAP does wind up competing against some of the other practice management systems mentioned in this report, says CEO Eric McDonald. "But we can easily win against guys whose products were designed to work OK for everyone rather than designed specifically for urgent care."
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