Community Health Center Information Systems Assessment: Issues and Opportunities. Final Report. Health Center Experience with Practice Management

10/30/2005

The widespread use of practice management systems stems primarily from the systems’ capacity to improve health centers’ billing capabilities and streamline general day-to-day management operations. Practice management applications are built to increase organization of billing data, catch wrong or missing data elements from encounter records, manage patient scheduling and check-in, facilitate eligibility determination, and coordinate the electronic submission of claims. 
As one health center respondent noted, “practice management is all about billing” — the potential for maximizing collections and payment options is key to health centers’ widespread investment in the systems.  As discussed earlier, health centers’ reporting requirements (e.g., UDS reports) are also an important impetus for the use of practice management.  Most practice management applications marketed directly to health centers have pre-designed reports meant to satisfy UDS reporting requirements. 

Practice management vendors.  The most commonly utilized products for practice management applications in centers we visited were Epic (eight centers), Medical Manager (nine centers), GE’s Millbrook (four centers), and HealthPro (five centers).  Among the few centers that had implemented an EHR, WebMD and Logician were the most frequently used. Consolidation between vendors, detailed in the environmental scan, is common. In the past few years, WebMD has acquired both Medical Manager and HealthPro.  Occasionally consolidation creates difficulties for health centers who have invested in one system only to see it bought out and upgraded — sometimes leaving the health centers in a position where they are unable to afford the new version but are without support for their existing system. 

Scheduling.  Practice management scheduling functionalities were widely reported to be of good quality and extremely valuable to health centers.  Many systems allow for double- and triple-bookings to accommodate transient patient populations and health centers were satisfied to have the ability to schedule patients to a specific examining room and provider. Most systems also target concerns specific to health centers.  However, some health centers had complaints regarding the usability of the scheduling module included in their practice management application, indicating that it was difficult to view data on missed versus completed visits on the schedule itself.

Billing and accounting.  Health centers generally indicated that their system’s billing and accounting modules were a significant improvement over prior systems they used. Claims are typically generated, sent, and reimbursed far more quickly with sophisticated practice management systems.  Most applications pre-screen claims before they are sent out in order to catch coding errors — some health centers reported that their systems occasionally fail to catch wrong or missing data, resulting in large increases in accounts receivable and decreased payments until billing glitches were fixed, but most respondents expressed high satisfaction with billing functionalities.  One respondent noted that “Commercial payers have never reimbursed as quickly as they do with the [new] system.”  In addition, all practice management systems have also been designed by their vendors to streamline compliance with HIPAA Electronic Data Interchange (EDI) regulations.

Electronic claims submission. Some practice management systems also support electronic claims submission capabilities.  In the health centers that made use of this functionality, we heard many positive reports about the systems’ success at making accounts receivable and cash flow more predictable, as well as about built-in logic to detect coding errors.  However, not all systems’ billing formats accommodate Medicaid or other payers’ electronic submission requirements.  Additionally, some payers have not set up a system to receive, process, and remit electronic billing and payments.

Reporting.  Reporting capabilities are a key aspect of practice management systems. Health centers generate a wide variety of reports, from the basic to the very complex, and practice management systems are designed to accommodate a range of needs.  Although most case study respondents were enthusiastic about the better quality and easy access of data managed in their system, some indicated that the reporting modules are not always user friendly.  Designing and generating custom reports requires use of specialized applications such as Crystal Reports, which require a significant level of training to master. Because health centers often do not employ staff with these skills, they rely largely on networks or vendors to design needed reports, at substantial additional cost, delay and inconvenience.

Overall, the role of and rationale for practice management systems is clear: The applications are ubiquitously reported to be superior to the health centers’ prior systems; the return on investment from billing improvements is considerable; and HIPAA compliance is ensured by the vendor. Respondents agree that most functions perform smoothly and that the systems have made a significant difference in their accounts receivable, reporting capabilities, and day-to-day operations. 

However, health centers still struggle with some functionalities and interoperability issues.  Many cite difficulty with billing formats that accommodate Medicaid or other payers, and reliable, convenient and customized reporting can be difficult to obtain.  Those centers with in-house technical staff trained in reporting software, as well as those in highly centralized networks with access to outside reporting expertise, tended to fare better with their systems’ reporting functions.  In addition, most practice management systems are not interoperable, creating problems for health centers attempting to build a common data warehouse, given that custom-built interfaces are expensive.

Lastly, health centers respondents emphasized the importance of systems support and vendor management.  Health centers that have responsive relationships with their practice management vendor are far better able to customize their systems and address problems, which greatly enhanced their overall implementation and daily use experience.  We found that individual health centers often find it difficult to obtain a desired level of service from vendors.  The considerable flux among vendors and products, discussed earlier, also presents a challenge.

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