The EMR Conundrum

The enigma surrounding the pilgrimage of acquiring & adapting to a medical EMR is daunting. Bottom line is the MSO and PDA/IPA totally accept the need for an interactive, productivity enhancing EMR. The fact is many physicians are dragging their feet in committing to an EMR. They have good reason for hesitation. The major issues of EMR expense and ease of use continue to be hindering factors to adaption. Plus, the all important sense of confidence with the everyday adaptation is a significant concern. Hardware and system costs are just part of the expense issue while training, balky data exchange, etc. are irritating provider and staff issues.

Issues also must correlate with the appropriate expectation of a material addition of profitable new business. New revenues have to accompany and fund an anticipated EMR purchase and adaptation. Add in the governmental threat of a high-dollar charge to go with not meeting CMS performance expectations. Those CMS-promised penalties for poor performance may encourage physician dropouts. These are major MSO concerns at the mid-point of the 2016 business year.

The MSO wants to pursue pay-for-performance. The price for a PDA-sponsored EMR could be $50,000 ±. The commonplace issues, compliance liability, and fully costed implementation are serious in their own right. But, a successful EMR must have clinical and data exchange with financial integration. This has to be done. Failure is going to result in fines, benefit plan push back, and practitioner dropout from CMS. The MSO management is working overtime to figure how to approach this puzzling, complex, and potentially destructive issue.

Your insight and experience is solicited. It is now time to fully engage this issue. The Physician Organized Delivery (POD) model is on the drawing board for PDA. The major hospital CIO model remains a challenge. ACO options are numerous. This is the bridge to be passed to reach the upside revenues of pay-for-performance. And, it must be done in a manner that saves the existing at-risk primary care cadre.

The IPA also needs to coordinate with benefit sales to commercial and governmental insurance. That is essential to survive in the new oncoming paradigm.

Healthcare’s Attendant Costs

A friend of the IPA faces the challenge of a cancer diagnosis. He has decided to deal with that situation with the help of M.D. Anderson in Houston, Texas. He is a strong, brave person who is up for a fight and we wish him all the best.

In discussing his insurance benefits with us, he has told us that it is the “surprises” that get him down. For example, the chemo medicines have surprises. But, so do the incredible freeways of “H Town”, van rides from the airport to the Houston Medical Center, and so many other new experiences that amount to “surprises”. Undoubtedly, traveling to a treatment site in another city or just across town has a lot of surprises and new experiences to master.

Patients often complain about one other very serious surprise. When one has health insurance and major medical, there is also a degree of anticipated mental preparation to face the financial costs of cancer. But, no one ever thinks about the costs that occur because of the trips, hotels, meals, childcare, and other miscellaneous. Such expenses are very real and they do add up to expense not easily planned for and often unavoidable.

There is indemnity type insurance for these expenses, but few “buy/purchase” the peace and security provided by ancillary coverage. Simply put, an example of this type of coverage is an ancillary plan that pays a fixed amount on the first day of a cancer diagnosis. This type of insurance can save the family great heartache and goes a long way to protect the patient’s credit status. Such coverage should be tailored with the employee benefit plan.

I have developed a relationship with professionals that represent this type of product and the skill to place it. I am going to ask them to call on the MSO workers that serve PDA. And, I hope they will knock on your door and ask if you would like to see how this coverage works. And, you will be impressed by the financial value vs cost in relationship to major medical insurance.

The general ancillary plans are disability, accident, life, cancer, critical illness and other interesting options. The lead professional that understands this product is Georgina Milum. Her phone number is 214-755-7518. Think these niche solutions over as presented by Georgina and her staff. She will share both her technical expertise and a gift of empathy that few possess.