If you read HIStalk, you may be familiar with the segment Curbside Consult from Dr. Jayne, which describes some of the challenges she has encountered with newly acquired physician practices as she tries to bring them into the fold of her large healthcare enterprise. In addition to the complications of standardizing these practices on one EHR, she has discovered physician resistance, compliance worries, and several unexpected obstacles along the way.
This is a not a new problem, but one that is compounding as integrated delivery networks (IDNs) and large health systems strive to deliver high value, patient-centered care while shifting healthcare services out of the hospital and into outpatient centers. Consolidation of physician practices, through mergers or acquisitions, may have peaked, but the need to integrate those practices to achieve a true return on investment (ROI) is now paramount.
Here are three factors that impact the success or failure of integrating practices:
Rapid pace of acquired physician practices
Organizations have acquired practices to stay competitive and grow their network of services. While there may be long-term benefits for both, the pace of acquisition is largely based on business needs— not on those of patients or physicians. With the incorporation of hundreds of newly-acquired practices come hundreds of different administrative and clinical practices, and varying cultures and expectations. Standardization is key to ensuring consistency, quality, and compliance, so look for best practices to expedite the onboarding process.
Integrated delivery networks (IDNs) should simplify integration for the acquired practices, establish standards and work with existing partners on plug-and-play tools to help organizations address some of their immediate challenges with technology, compliance, and patient clinical records. Developing playbooks to standardize clinical documentation and providing guidelines to ensure the efficient transfer of comprehensive and timely data needed for quality patient care will help people on both sides of the acquisition. For example, delivering standard letter heads, policies on mobile devices, turnaround time for records, and guidelines for physician signatures on charts through autofax or mobile devices will help get clinical staff using some consistent health IT elements more quickly.
Ambulatory care is important, but resources are scarce
When organizations acquire physician practices, they often find disparate clinical documentation. Some use EHRs, some using medical transcription, some use front-end speech recognition and others may use scribes or scribble notes and orders on paper. What IDNs need is to quickly get these newly-acquired sites to adhere to enterprise-wide standards, adopt shared technologies, and to welcome change with open arms. What they’re finding is something very different. There is often a lack of support for these new teams and practices. Practices need guidance and support as they learn to navigate a new system and organization. I’m seeing frustration and lack of control on both sides— neither has a sense of what the other is doing or what they need.
A return to the hybrid documentation approach
In the last three years, many have learned that forcing a one-size-fits-all EHR approach on physicians can be costly. Everyone expected some pushback when implementing point and click documentation within EHRs, but what they found was that this also caused a big drop in productivity, which was costly. Since physicians generate an average of $1.4 million annually each to the revenue of their affiliated hospitals, it is counterproductive to make documentation too long or too hard for physicians. No-one wants to make that mistake again, and with the next stage of Meaningful Use deadlines looming, C-suite executives are eagerly exploring tools, services and strategies to make it easier for clinicians to deliver fast, reliable information into the EMR. How it gets there doesn’t matter as much as long as it’s complete, compliant, timely and secure.
People now realize that all clinicians and practices do not all work the same– not in their clinical documentation, with their patient cases, or their workflows – and interfering with those come with consequences that can be measured in dollars, wait times and patient satisfaction scores. Some physicians and practices have complex patients and deal with large amounts of information, while others work in a faster-paced environment with short cases and very high patient volumes. I’m seeing a return of hybrid methods of documentation to meet the needs of physicians practicing in acute care as part of a big IDN, while also offering options designed to keep clinicians happy and product in ambulatory settings to help them exchange patient data quickly across care areas. What is needed is flexibility that allows physicians to create a fast and accurate patient record that can be quickly incorporated into an online record, included in data analytics for the enterprise, and produces outcomes reporting.
Like any new relationship, integrating acquired practices requires basic relationship-building skills. To make integration go more smoothly, executives need to understand the unique needs of these practices and support their different workflows and expectations of patients, while newly-acquired practices need to be open to the new protocol and procedures of their IDN, which are designed to improve the flow of information, standardize care and drive better quality outcomes. Investing the time in implementing these strategies enable your organization to create a process for repeatable and predictable patient care.