The implementation of the ACA means that there are thousands more patients coming into local health systems. There is also a trend of larger heath care delivery systems acquiring and/or affiliating with smaller hospitals and physicians to leverage economies of scale to meet regulatory requirements and secure the share of local markets. These trends often mean that health care leaders must examine information systems strategies at a macro organizational level and make key vendor decisions about which HIT solutions to maintain and grow or eliminate as a part of overall systems integration planning.
One of the key decisions that leaders face is whether to bundle financial (registration, scheduling, and billing) information systems along with clinical (EMR) systems in monolithic vendor strategies or whether to spread risk and have varied HIT vendor partners for clinical and business solutions while implementing an interface solution.
To prepare:
- Read the Learning Resources and research references regarding IT strategies, specifically best of breed and monolithic vendor systems used to achieve integration.
- Consider private payers including pay for performance “bundled” payments as discussed in the Dynamic Scenario in Week 4. How do private payers play into your thinking about clinical and financial information systems strategies?
By Day 3
Post:
A recommendation of either a best of breed or monolithic systems integration strategy. Justify your recommendation. Evaluate the issues involved in each. Describe how private payers play into your thinking about clinical and financial information systems strategies. Describe the role of vendor/client site relationships in these types of decisions. Support your rationale with references.
THIS IS THE DYNAMIC SCENARIO
Scenario:Dynamic Health System is a 3-hospital, 500-bed system in the Midwest United States. This system employs 100 physicians, both primary care and specialists, in 12 physician practices. Dynamic also runs a center of excellence in orthopedic care for the large geriatric population in the area, including an outpatient rehabilitation facility that is currently profitable. Dynamic offers a full spectrum of medical and surgical services to their population with an emphasis on programs of excellence in orthopedic surgery, diabetes, and women’s care.
Dynamic’s typical patient mix is over 45% Medicare with another 35% private pay patients covered by three large insurance companies. Their Medicaid population is approximately 12%, with the reminder of patients self-pay.
Due to market forces, the three private payers have begun to implement a program of bundled payments for their members in the following areas: hip replacements, knee replacements, and lower back surgeries. In these models, Dynamic hospitals and employed physicians will be paid a fixed amount for an entire episode of care from pre- surgery evaluation, through surgery and post-surgery, physical therapy, and rehabilitation. Medicare is likewise proposing a pilot study for a population of hip replacement beneficiaries to assess the outcomes of care as opposed to procedure costs as a result of Dynamic’s petition to receive increased payments for beneficiaries due to age demographics and for being the only orthopedic geriatric center in 200 miles.
As a result of these factors and the aging HIT infrastructure, the Chief Medical Officer (CMO), Chief Executive Officer (CEO), and Chief Information Officer (CIO) of Dynamic are proposing the purchase of a monolithic Electronic Health Record (EMR) solution that will provide complete online documentation, orders, pharmacy, labs, and patient portal for all hospitals and employed physician offices. Because the (1) physician offices are currently using Epic Corporation’s back office billing system with an outstanding record of accurate coding and short “days in Accounts Receivable” and (2) Epic’s EMR has a high ranking in industry HIT assessments, the executive team is proposing the purchase of Epic’s clinical EMR (documentation, ancillaries, orders, and patient portal).
The CFO is supportive but skeptical, as the Epic bid is approximately $1.5 M to implement the clinical software with a continued $300K per year in software maintenance and support. Current clinical technologies information systems are fragmented, disjointed, and don’t meet HITECH Meaningful Use requirements, and it will cost Dynamic about $200K per year to maintain the software and servers needed to run the system.
The local competitive landscape may be changing. Dynamic’s CFO is hearing rumors that an established academic system which is centered 300 miles away is possibly considering buying three local stand-alone surgery centers and hiring orthopedic surgeons. This academic center has published best practices in outcomes for surgery care in a recent CMS Medicare study that implies that they are delivering high quality and cost effective orthopedic care.