EMR and Practice Management Replacement 101 - 8 tips to get you started (bt)

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If you are considering replacing your EMR or Practice Management Software, or both, here are some helpful tips to help optimize your investment of time and money. - 8 tips to get you started!

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EMR and Practice Management Replacement 101 - 8 tips to get you started (bt)

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When the Centers for Medicare and Medicaid (CMS) Innovation announced plans to select organizations for its Shared Savings Accountable Care Organization program in April 2011 via a proposed rule, reactions within the healthcare community were mixed. Some were excited by the prospect of a push for more coordinated and integrated care networks, while others criticized the specifics of the proposal, concerned that the level of provider risk and other provisions would make the model unsustainable over time. Subsequently, the Centers for Medicare and Medicaid Services (CMS) issued a Final Rule on Shared Savings Accountable Care Organizations (ACOs) that was much more positively received throughout the healthcare community. CMS then followed the Final Rule with an April 2012 announcement, adding 27 initial Share Savings ACOs to its original 32 Pioneer ACO group. With this backdrop in place, it’s clear that accountable care is more than the latest healthcare buzzword. Today, there is a clear change in the focus of healthcare providers, with an emphasis on shifting the focus of payment for hospitals, physicians, and other healthcare entities towards integrated care and a focus on value and quality of care rather than the volume of services provided.¹

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Whether referred to as integrated healthcare or accountable care, the current focus on new healthcare models is a reaction to long-standing concerns around quality, cost, and efficiency. Many of these issues stem from care delivery systems that have been: • Directed more at episodic treatment than prevention and early intervention • Fragmented rather than integrated and coordinated • Focused on patient eligibility and billing rather than patient engagement within and outside of the care setting • Customized to the idiosyncrasies of individual facilities rather than standardized across care sites • Rewarded more for volume than for quality and cost outcomes The resulting inefficiencies have made healthcare less effective, less safe, and more costly than can be tolerated, particularly against the backdrop of a challenging worldwide economy. The old dictum ‘if you provide healthcare, they will pay’ no longer applies. Public payers, private payers, and regulatory agencies are wielding both carrots and sticks to drive healthcare organizations toward greater coordination, demonstrable quality, and measurable cost control. The consensus on what ails our health systems, as well as the availability of new technologies, has led to the creation of new models of delivery, such accountable care organizations and integrated health organizations. By whatever name, these healthcare models are designed to promote accountability and improve outcomes for the health of a defined population.

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For large hospitals and small provider practices alike, healthcare reform and changing reimbursement models have introduced significant new challenges to the business. It is now more important than ever for organizations to have a well-designed revenue cycle management (RCM) strategy in order to optimize their revenue cycle, prepare for change, and maximize revenue. At the same time, mergers and acquisitions among U.S. hospitals and physician practices add to operational complexity, and with most hospitals employing a wide vendor portfolio of HCIT solutions, these challenges further the importance of running a tight financial enterprise. The inability to effectively monitor and proactively manage the revenue cycle can destroy profitability and make it difficult to focus on what matters most — delivering outstanding care to patients.

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