By Jack Ahern, MBA
As I write this we are still waiting for the issuance of the final rule on the new ESRD bundle which gives me a little more time to provide some insight on how to prepare for the decision making and analysis that will be required as we transition into a new, and hopefully improved, methodology for ESRD payment.
Over the years I have been asked to assess, as an independent voice, the advantages and disadvantages of a variety of billing and accounting systems available to, or specifically designed for, dialysis organizations. I have enjoyed these projects and would like to share, from a high level vantage point, some of my experience in assessing clinical management and financial management packages. Although I will not comment on any one system per se, I would like to point out some general issues, equally applicable to the selection of most financial management and clinical management applications.
Firstly, it should be understood that when the vendor is demonstrating a financial and clinical management product, often bundling some aspect of billing functions with clinical features pertaining to tracking medications, treatment parameters and scheduling, the vendor commonly will use a demonstration-only database, with fictitious patients and payers. The vendor may also point the prospective buyer in the direction of a well-established and relatively satisfied user of the package. The benefit of this approach is that with the demonstration database and application you may get to see the full, theoretical potential of the program, with all possible features. Likewise, the pre-existing customer will let you see, hands on, a working version of the billing/clinical management system, and perhaps give you some details regarding the challenges and real-world benefits.
However, the drawbacks of vendor-directed research is that you may not get to see the full spectrum of problems faced by any, perhaps several, less than satisfied buyers, but these may be the problems most directly impacting your satisfaction and use. Moreover, it is rare to have another buyer let you see and compare the exact financial terms and payment structure for the system.
So where does this leave you? Obviously, it is good to network within the industry and ask your contacts what they are using and gather inside, non-vendor directed information. But this approach also is fraught with problems since anecdotal information is not always accurate. For instance, a particular contact of yours may have had a serious difficulty with a particular system, but that may have been solved in a recent update. Also, your contact may be more interested in one positive aspect of the package pertaining to a specific task, and less interested in other aspects that do not directly impact your friend’s responsibilities and goals. Perhaps the billing package is very good at tracking meds and labs, but not so good at financial reporting. If your contact is a financial person, negative comments may be more dominant due to the financial challenges, but the same system may be the darling of the clinical staff.
Seven Ways to Ensure You Get the Best System
Here are some suggestions to get the best system and avoid some unpleasant, unexpected and expensive discoveries after you have purchased the new system.
1. Look to your most important present and future needs first. For instance, a major financial or clinical management decision may require information you presently struggle with. This may trump a neat feature that is lots of fun, but less relevant.
2. Use a team-based approach to assessment. Include on the assessment team every job function and discipline, and represent all those who will directly or indirectly use this system or have used other systems.
3. Perhaps most importantly, avoid giving a dominant voice to any product champions, especially those with influential positions. This can create a group think mentality. It is hard to disagree with your boss (who may have been appropriately romanced by your vendor) and loves a specific system.
4. Use objective factors and numerical assessments, such as ease of use rated from -10 to 10. Be as specific as possible.
5. Remember, the more user friendly an application the better information you will get and use.
6. Try to find other users, similar to you, who were not selected by your vendor.
7. Assess the quality of proposed financial arrangements, especially reporting packages, warrantee service, and upgrades, as much as the functionality of your system.
So, what are your thoughts on your financial and clinical management system? As always, feel free to drop me a line at jahern@ahernconsulting.com and let me know what you think. RBT
With offices are located in Chicago and Washington, D.C., Jack Ahern provides cutting edge financial and management consulting services to major academic medical centers, large national dialysis organizations, independently owned dialysis facilities, nephrology groups, as well as to legislators, institutional investors, pharmaceutical companies and medical device manufactures. He and has a MBA from the University of Chicago, and several undergraduate degrees in the physical sciences from Dalhousie University. He can be reached at (312) 997-2177, ext. 701.
