The Brave New World of Information Technology: How IT is Transforming Practice Management
September 2008 Issue
O&P professionals are becoming denizens of the information age. According to Elizabeth Mansfield, Outsource Marketing Solutions, nearly all U.S. practices have at least one computer, and overall, the profession is adopting more advanced digital technologies at a wide range of rates and scales. Myriad solutions are available to supplement every aspect of O&P work, from electronic medical records to employee scheduling to product production.
However, for many practices, embracing information technology is akin to wearing a microprocessor-controlled knee after years in a wooden leg-it's an innovation that lets them traverse unheard-of territories of patient care, efficiency, and financial rewards. At the very least, an increasingly digital world might lure them from the typewriter and filing cabinet. But there are other incentives as well. On July 23, 2008, the U.S. House of Representatives Energy and Commerce Committee approved HR 6357, which would provide more than $560 million in grants and loans for healthcare providers who adopt electronic health records. Furthermore, a representative of the Georgia Institute of Technology (Georgia Tech) reports that many graduates of O&P degree programs seem quite interested in entering technologically advanced practices, which may reduce hiring choices for less technology-friendly practices. Patients are also in on the trend. According to Dennis Clark, CPO, president of Point Health Centers of America, Waterloo, Iowa, and president of Clark and Associates Prosthetics & Orthotics, patients and their caregivers are now researching products, pricing, and practitioners online and are arriving in consulting rooms armed with educated questions that they expect to have answered at the speed of Google*.
Due to the complexity and variety of available software and hosted solutions to assist practices in managing their business and clinical aspects, this article focuses primarily on the business side.
To Buy or Not to Buy
A small practice may not currently, or ever, be ready to enter the digital age. A practitioner with many years of experience and a well-trained administrative staff may be satisfied with the size of his or her practice and its functioning. Or, practice managers considering the digital route may want a judicious research period before investing thousands of dollars in technology and training. According to several O&P software vendors, management software for a three-practitioner practice has an estimated price tag of $4,500 to $11,600 for installable packages that are used on internal computers or servers, while subscription-based online services start at about $3,300 per year. These costs may not include training expenses and don't account for the staff time used in the ramping-up process. When Clark purchased Brightree's solution, he was committed to having his entire staff at Clark & Associates learn every applicable aspect of the system. It took four and a half months for them to fit training in around practitioner's schedules. He says he knows of practices that came online in six weeks.
Choosing a software package also means committing your past and future data to a new format, one that may be difficult to back out of. Ted Muilenberg, CP, Muilenberg Prosthetics, Houston, Texas, waited almost a year between signing on with Brightree and actually using the system, while Brightree converted nearly 20 years of his old data from a format that was obsolete. However, Mark Blount, vice president of marketing at Brightree, says that "the data migration portion of an O&P implementation typically takes 30 to 45 days," and of the more than 750 companies currently using Brightree, the company has taken "the vast majority" through a data conversion process to migrate information from their old systems.
E-Mails and Modules
Fortunately, for every practice, from the solo practitioner just entering the electronic world to the multi-office corporation, options exist that can provide maximum value for the time and money. For practices that are ready to begin incorporating some electronic information technology, modular and single-purpose solutions are a relatively simple and cost-effective way to improve efficiency. Such technologies can also work well for larger practices, allowing them to mix-and-match functions according to their needs.
E-mail may be the first electronic foray for some practices. Programs such as Microsoft Outlook™ are feature-rich and available for most computer platforms. For practices that are not ready to invest in software or that want check-anywhere convenience, the web browsers Yahoo™, Google, and MSN™ offer free e-mail services that can be accessed from any Internet-connected terminal.
Digital dictation can be another time-saver. Recorded practice notes can be uploaded to an online service, such as scriptacom.com , that returns the notes within a day or two for a fee. Or, notes can be entered into an in-house voice-recognition program, such as Nuance's Dragon Naturally Speaking™, which transforms sound into text.
Scheduling programs can allow practitioners and administrators in a multi-location practice to schedule patients for appointments at any of their various locations from a single terminal, and web-based versions, such as Appointments Pro™, allow users to check their schedules from any computer in the world.
Inventory management, billing, and purchasing programs can improve revenue streams and save time. Some complete practice management programs, such as The O&P Hub Lite™ and Acc-Q-Data™, are available in modules that allow users to add one function at a time. Bridgepoint Medical, Lexington, Kentucky, has adopted a modular approach, using OPIE for clinical management, Acc-Q-Data for billing, and Quickbooks for financials.
Such single-function programs can handle discrete functions and be integrated into larger data-management programs. However, for those who are looking for a comprehensive solution, most modern practice management systems offer integrated functions that can improve the efficiency of every aspect of a practices workflow. These systems can help fulfill important management goals, such as better customer service and increased cash flow.
Most also provide sophisticated reporting tools that churn raw data into easy-to-use statistics for proactive decision-making, which can help practitioners achieve better patient health, a more satisfying career, and more successful marketing to both referral sources and patients.
For new practices, purchasing practice management software early may be an investment in the future. Jeffrey M. Brandt, CPO, is CEO of Ability Prosthetics & Orthotics Inc., Gettysburg, Pennsylvania, a four-office practice. When he founded his first one-practitioner office in 2004, he used paper charts for the first six months so that he could organize his business processes before adopting OPIE Software. He recalls, "I made an early decision that it was going to be a cornerstone and a platform for our growth and for patient care continuity to be able to allow practitioners and administrative staff to go to one place to find information about patients or vendors or a host of other things, but primarily daily functions-patient information, billing, or administrative information, demographics on the patient, to information about their components and what device they are going to be receiving and to be able to share [that information] across subsequent offices."
If you have an established practice, jumping onto the techno-management bandwagon may require more than just calling a rep and loading software or signing on to a web-based system. Lisa Lake-Salmon, executive vice president of Acc-Q-Data, Boca Raton, Florida, cautions that using new technology will not solve pre-existing workflow problems. If your business processes are smooth and efficient, incorporating practice management software will improve on the existing efficiency; however, if your workflow processes are broken, "it will just create more complexity and confusion," she says.
James Clifton, COO of Bridgepoint, says that "the process of re-engineering... where you take a paper process and re-engineer it, [from that] you're going to see incredible gains in efficiency and productivity.... [After acquiring a new practice], we start with the basics of process engineering, and within six months we can see fairly drastic improvement, which then sets the tone and the foundation for applying technology 5
Promises and Perils
But what happens once a practice has successfully adopted new software? Some experience both radical gains and serious challenges. Take, for example, the ordering process: several practitioners described to The O&P EDGE how in paper-and-pencil practices, even successful ones, it took days or weeks for a product to be ordered after a patient s initial visit. After the exam, the patient s chart was handled by several staff members, patient information was manually entered and re-entered into multiple forms, clinical notes were transcribed by hand from notepads or scraps of paper, L-Codes were looked up in books and then entered on several forms, inventory was checked by eyeballing, orders were placed by telephone or typed out, non-inventory parts were ordered in the same ways, and everything was rechecked several times before delivery.
With practice management software enabled, this process looks entirely different. Jonathan Shinn, director of operations at oandp.com , which produces OPIE, describes how a software-using practitioner in the same situation might work instead. She or he would open the electronic file on a computer in the examination room, see the patients clinical information from every previous visit, then during the course of the exam or immediately after, would update the information, choose L-Codes and componentry, and then set up or assign fabrication tasks, all with a few clicks of a mouse. All of the patient s information would be automatically transferred to approval and compliance forms as they were created, and the system would allow the practitioner to monitor the status of all processes. The increase in efficiency can be remarkable. Brandt says that at Ability, from the time a patient leaves his or her initial evaluation until the practitioner has entered L-Codes and placed the order, only about five to eight minutes pass.
Improving administrative processes does not necessarily mean all aspects of patient care are improved. Brandt describes how some Ability patients initially felt less-than-fully attended to when practitioners began using computers in clinical settings. Now, he says, all Ability practitioners are trained to spend the first 15 minutes of any appointment relating to the patient without electronic accompaniment. They then explain to the patient that they're going to use the computer to make sure that all of the patient's information is recorded permanently and accurately. "Then," Brandt says, "they love it."
Technology can also change other kinds of interactions and roles. Front-desk administrators end up with novel responsibilities, while new hires require more training and computer literacy. There also may be less need for authorization and billing specialists. Brandt finds that with OPIE software, he needs only a single authorization specialist and a single biller for his entire company. Lake-Salmon adds, "the office starts to move at a more efficient pace. Speed of information tends to uncover other issues that have been lying just under the surface, and all sorts of other questions start to get asked. 'Why do we consistently get denied on a specific code? Why does Dr. X always forget the necessary documentation?'"
Becoming a Power User
This is the stage at which Brandt says the system becomes a management tool. "Then, finally, you've hit the home run.... You can do things like understand your spending.. .concentrate your contracts with vendors, get better vendor terms, understand your patient flows, and drop unprofitable product lines." Clark says that using Brightree's "specific, customized reports, which are in an easily recognized format" helps his staff plan personnel schedules, inventory, and hours of operation.
They also can lead to better patient care in a number of ways. Brandt's staff found that patients oftentimes called for certain kinds of maintenance information about three weeks after an initial fitting because they had lost their health instruction sheets. At two and a half weeks, Ability now automatically sends a new set of information to each patient.
As our culture becomes increasingly information-saturated, more patients may come to expect such information-readiness from practitioners. "Practitioners now have to be able to provide financial answers to patients," Brandt adds. Using most practice management solutions, one can call up the pricing on individual prosthetic and orthotic components, then estimate the likelihood that Medicare will approve a particular percentage of payment.
Referral sources may also appreciate this convenience. Practitioners at Clark & Associates meeting with referral sources can "very accurately" talk about patient demographics, diagnoses, and timelines from prescription to delivery and follow up, according to Clark. As an added benefit, they can provide this data to the referral source in electronic formats. Terry Long, president of Futura International, Clearwater, Florida, believes that function brings more clients to Futura users. "By having all the electronic record capability for their practice, they can... provide the same information [including] photos of patients and progress notes that were electronically created.. .back to the physicians," she says. "Now they're improving his records."
More than 15 companies offer practice management software marketed toward O&P, and they're all fighting for practitioners' business. Lake-Salmon named the benchmark characteristic of most of these packages: "Patient records, insurance verification, claim status, product information, etc., can be accessed whenever it is needed by the touch of a button," and in web-based products and server-based products that are accessible by the Internet, "you do not have to be in your office at your desk to view this," she says. "Being able to access such information from anywhere, anytime allows the practitioner and... staff to work more easily without having to be in the office at all times." On top of this, most companies have some distinguishing characteristics that may make them more appealing to some practices. Acc-Q-Data, for instance, began life as a billing company. According to Lake-Salmon, companies such as Bridgepoint use it partly because," [Acc-Q-Data] is geared toward billing efficiency, designed by coders and billers with over 14 years experience strictly in O&P billing. We also offer billing assistance and billing webinars for our software customers to ensure they receive maximum reimbursement. Other software companies are software only and do not assist in billing or denials in any way"
OPIE, on the other hand, is practitioner-centric. Brandt chose to base his practice on OPIE because it was designed by Paul Prusakowski, a CPO. According to Shinn, "OPIE's architecture is designed for efficient, seamless O&P workflow, in the office or onsite-the measurement and fabrication forms, approvals, and clinical data...and it's not unheard of for our full-time development and support team to develop...or add new features for a single practice."
Pacware Software Solutions offers versatility, with a point-of-sale system for over-the-counter sales and an autodialer for calling patients with reminders about appointments and recurring supplies. According to Dan Cahoon, Pacware's vice president of sales, they charge practices nothing until all data conversion, on-site training, and installations are complete, charge no per-user fees, and offer both web-based and server-based applications.
OPGA and Clark both chose Brightree partly because it's built exclusively for the web. Clark said, "We don't own the software. That forces Brightree to be on their toes all the time. They've got to perform for us every single month because we can always go out and buy software and put it in-house. And we own all of our information [while] they own our IT issues, and I like that a lot."
Futura International is dedicated to fully automated, paperless solutions. According to Long, Futura is "one of the few packages that supports digital signature collection, so while [practitioners are] out in the field scanning photo IDs and insurance cards and taking all that information without making copies, this real-time information is instantly at the main location, where they in turn can provide electronic receipts, thank you letters, and automated surveys, and also send informal progress notes to the referring physician, which is a great marketing tool."
These characteristics may or may not draw practitioners to buy in. Hanger Prosthetics & Orthotics, Bethesda, Maryland, developed its own internal practice management software, and Shinn says that oandp.com offers an administration-only version of OPIE partly because some practitioners "simply aren't ready to regularly use a computer." What's certain is that the diversity of practitioners' needs and interests will continue to spur on software developers, ensuring that as their customers' practices change and evolve, the technology will stand ready to assist in that evolution.
Morgan Stanfield can be reached at
Editor's note:The O&P EDGEdoes not endorse any products or vendors. This article does not attempt to cover every software and hosted practice manaqement solution available on the market today, but rather to present readers with a representative samplinq as well as an overview of the impact such technoloqies are havinq on O&P practices.