Acquisition of physician practices is a growing strategy as hospitals and health systems strive to maintain a competitive advantage in their markets. This trend is expected to continue according to a survey of healthcare executives, 52 percent of whom said their facilities planned to acquire physician practices in 2013 as compared to the 44 percent who purchased practices in 2012.
As practices are acquired, regulatory mandates such as meaningful use of electronic health records and new financial models that emphasize cost-efficiencies, such as accountable care organizations, increase the need to connect all providers' EHRs, as well as ordering and reporting functions to enhance collaboration. Effectively integrating into a practice's EHR gives a hospital the unique opportunity to provide a competitive service to that practice and drive lab and diagnostic orders to the hospital in a way that better serves the community while increasing revenue for the hospital lab.
The growth of acquired practices presents challenges for health system laboratories and diagnostic imaging services that must serve an increasing number of customers outside the four walls of their organizations. Hospital-based services were designed to handle orders related to acute care, relying upon internal registration and patient records systems to provide access for transmitting orders and receiving results.
The need to connect to multiple, disparate EHR systems that may or may not have the capability to create a "clean and complete" order or to transmit electronic orders presents an interoperability challenge. Overcoming the challenge is necessary if hospital-based services are to successfully compete with reference laboratories that have already invested millions of dollars to tackle the challenge of integrating to physician EHRs.
Connection must fit workflow
Achieving interoperability requires more than technological tools and savvy. Physicians must see that the connection to the hospital lab or imaging service will enhance, rather than complicate their office workflow. The setup of their EHR orders environment should be simple and predictable, and the order created in the EHR should abide by the lab's ordering rules, making it "clean and complete" with full insurance information, clinical Ask at Order Entry questions answered and requisitions split according the specimen type or according to billing rules.
Lastly, it is essential for lab managers to ensure collection of all revenue that is due. A hospital lab that receives 210 orders per month from 330 physicians, with 20 percent of those orders covered by Medicare, can expect to write off a percentage of the Medicare orders due to incomplete diagnosis codes or other information required for payment. Rather than take staff time to call the physician's office multiple times to obtain the information, many labs opt for a write-off if the information is not easily obtained. If only three percent of Medicare labs are written off, the total could be over $150,000 each month for this example.
Finally, your hospital lab has to contend with connecting with dozens, perhaps hundreds, of different EHRs. Connecting those individual practices efficiently requires knowledge of each EHR system, its "language," how it fits the practice workflow and how to manage a multitude of individual connections. A dedicated staff and financial resources are required to design, implement and maintain each connection — resources not normally found in a hospital lab or imaging service.
Offer features that add value
The lack of staff and financial resources, as well as the interoperability challenge, can be resolved through the use of an intermediary to handle workflow between physicians, laboratories and imaging services. The solution should provide the following capabilities to meet the needs of the physician practices as well as the diagnostic service:
- Integrate, aggregate and normalize data in the cloud to avoid costly technological upgrades to existing EHRs and lab interfaces, and provide a single point of connection;
- Model your lab's compendium and your specific routing and splitting rules and instructions to produce a "clean" order and prepare patients for tests;
- Provide real-time information to physicians to support point-of-care decisions such as alerts when a test has already been performed by another physician or availability of less costly, but evidence-based alternatives to a specific study or test;
- Fit the physician practice's normal workflow so efficiency and productivity in the practice is enhanced, not interrupted;
- Deliver results in formats that are individualized to each practice's needs, including use of mobile technology; and
- Produce a scalable service that quickly adapts to growth and adds new practices in short timeframes.
In addition to meeting today's need to connect physician practices and drive lab and radiology orders to hospital services, diagnostic service results that are collected and normalized to ensure access to all records builds a repository of information the healthcare organization can use for population health management. This benefits the entire health system by enabling collaboration and developing best practices for cost-effective, quality patient care.
When physician practices connect to diagnostic services, the hospital enjoys financial, compliance and marketing benefits. However, it is essential to keep the physician as a customer in mind. The solution must add value to the physician practice — with real-time information, timely results and workflow improvement for the practice — to optimize use of the service.
Gary Palgon is the vice president of healthcare solutions for Liaison Healthcare Informatics, which provides healthcare organizations with innovative solutions to complex integration and data management needs. He can be reached at gpalgon@liaison.com.