Assgn 1HI

© 2016 Laureate Education, Inc. Page 1 of 2

Independent Physician Office Scenario Partners in Health Care Associates (PHC) are a four-physician practice located in the Midwestern United States. Three physicians are board certified in internal medicine and a fourth is certified in geriatrics. The practice also has a full-time nurse practitioner, three part-time nurses, two medical assistants, and two front desk staff. Due to changes in physician leadership, the practice no longer has a functioning ambulatory electronic health record. There is a legacy physician practice management system in place for billing and scheduling which is no longer supported by the vendor but does process electronic claims. Current State The practice has not been able to participate in the CMS Meaningful Use program and is being assessed 5% reimbursement penalties on Medicare patient payments. Likewise, two commercial payers are offering pay for performance incentives for managing panels of patients with diabetes and asthma, but PHC cannot participate due to their inability to produce the required health maintenance clinical reporting for the program. The practice has an existing practice management system that does patient scheduling and automated claims submission via EDI (electronic data interfacing). This vendor system is unsupported and must be replaced as part of the search for an electronic health record. The goal of the practice is to be able to be financially and clinically viable and compliant with the CMS Meaningful Use phase 1 and 2 programs and prepared for Meaningful Use phase 3. Software vendors who have sold products to other physicians in the area have approached the medical director and administrator of the practice. These vendors include Practice Fusion and Next Gen. Recently a colleague of the medical director who has a practice in California is recommending that he examine a product called Athena. In addition, the Chief Medical Officer of Green Valley Regional Health System has approached PCH offering to implement and support Green Valley’s Epic Care product in this practice under an affiliate agreement. There is also an option to run an MSO (Management Services Option) of Green Valley’s Epic Practice Management suite for billing and scheduling. While PHC is an independently owned physician practice they refer about 65% of their patients to facilities and specialists of Green Valley. Currently PCH’s practice management system is non-supported by the vendor. Front desk office staffs have become very proficient in using this software to schedule patients, submit claims and follow up on denials. Office IT operations such as email printing and a basic website are run by a local information technology company who provides the services to PCH for a monthly fee.

© 2016 Laureate Education, Inc. Page 2 of 2

About 75 of the other approximately 100 independent primary care practices in the region run either Next Gen or Practice Fusion as stand-alone systems. About 15 practices who have been approached by Green Valley are in the process of implementing their affiliate version of Epic Care. Three of the other five practices are divesting their practices due to financial hardships and two of them are in negotiations with Athena. Environmental Factors When examining the patient mix for both Green Valley and the regional primary care practices we see approximately 40% Medicare, 20% Medicaid, and 40% commercial insurance patients. The main commercial insurance carriers are Aetna and CIGNA. Green Valley is in final discussions with CMS in formulating an ACO organization that includes their facilities, the physicians who are running on the affiliation agreement, and a long-term care partner. In terms of financial pressures both Aetna and CIGNA have launched aggressive pay- for-performance programs in areas such as diabetes management, asthma management, and medical management of congestive heart failure. For these programs, physicians who produce regular health maintenance reports on panels of commercially insured patients are receiving performance incentives. The reporting for these performance incentives is very similar to the core measures reporting requirement for the CMS program’s Meaningful Use phase 1. Another factor affecting the region is the launch of the standalone urgent care option called Doctors Care. These urgent care centers are open 12 hours a day, seven days a week and offer highly convenient urgent care and online care services to patients for non-urgent conditions. They have also recently begun doing campaigns to offer vaccinations, school and employment physicals, and health risk assessments required by Aetna and Cigna. Part of their overall customer campaign is a highly user-friendly secure Internet presence in the form of a consumer health record where consumers can do electronic visits and on-line chats with health coaches about common medical issues. What to Do? PCH must make a vendor choice regarding both a patient management and ambulatory electronic health record system. As the practice administrator you have been asked to investigate vendor options and provide an objective analysis to the PCH medical director. He has asked that this analysis include both standalone options and the Epic affiliate option offered by Green Valley. He has asked you to investigate at least three vendor partners and objectively document both the benefits and limitations of choosing each of these options.

© 2016 Laureate Education, Inc. Page 1 of 2

Independent Physician Office Scenario Partners in Health Care Associates (PHC) are a four-physician practice located in the Midwestern United States. Three physicians are board certified in internal medicine and a fourth is certified in geriatrics. The practice also has a full-time nurse practitioner, three part-time nurses, two medical assistants, and two front desk staff. Due to changes in physician leadership, the practice no longer has a functioning ambulatory electronic health record. There is a legacy physician practice management system in place for billing and scheduling which is no longer supported by the vendor but does process electronic claims. Current State The practice has not been able to participate in the CMS Meaningful Use program and is being assessed 5% reimbursement penalties on Medicare patient payments. Likewise, two commercial payers are offering pay for performance incentives for managing panels of patients with diabetes and asthma, but PHC cannot participate due to their inability to produce the required health maintenance clinical reporting for the program. The practice has an existing practice management system that does patient scheduling and automated claims submission via EDI (electronic data interfacing). This vendor system is unsupported and must be replaced as part of the search for an electronic health record. The goal of the practice is to be able to be financially and clinically viable and compliant with the CMS Meaningful Use phase 1 and 2 programs and prepared for Meaningful Use phase 3. Software vendors who have sold products to other physicians in the area have approached the medical director and administrator of the practice. These vendors include Practice Fusion and Next Gen. Recently a colleague of the medical director who has a practice in California is recommending that he examine a product called Athena. In addition, the Chief Medical Officer of Green Valley Regional Health System has approached PCH offering to implement and support Green Valley’s Epic Care product in this practice under an affiliate agreement. There is also an option to run an MSO (Management Services Option) of Green Valley’s Epic Practice Management suite for billing and scheduling. While PHC is an independently owned physician practice they refer about 65% of their patients to facilities and specialists of Green Valley. Currently PCH’s practice management system is non-supported by the vendor. Front desk office staffs have become very proficient in using this software to schedule patients, submit claims and follow up on denials. Office IT operations such as email printing and a basic website are run by a local information technology company who provides the services to PCH for a monthly fee.

© 2016 Laureate Education, Inc. Page 2 of 2

About 75 of the other approximately 100 independent primary care practices in the region run either Next Gen or Practice Fusion as stand-alone systems. About 15 practices who have been approached by Green Valley are in the process of implementing their affiliate version of Epic Care. Three of the other five practices are divesting their practices due to financial hardships and two of them are in negotiations with Athena. Environmental Factors When examining the patient mix for both Green Valley and the regional primary care practices we see approximately 40% Medicare, 20% Medicaid, and 40% commercial insurance patients. The main commercial insurance carriers are Aetna and CIGNA. Green Valley is in final discussions with CMS in formulating an ACO organization that includes their facilities, the physicians who are running on the affiliation agreement, and a long-term care partner. In terms of financial pressures both Aetna and CIGNA have launched aggressive pay- for-performance programs in areas such as diabetes management, asthma management, and medical management of congestive heart failure. For these programs, physicians who produce regular health maintenance reports on panels of commercially insured patients are receiving performance incentives. The reporting for these performance incentives is very similar to the core measures reporting requirement for the CMS program’s Meaningful Use phase 1. Another factor affecting the region is the launch of the standalone urgent care option called Doctors Care. These urgent care centers are open 12 hours a day, seven days a week and offer highly convenient urgent care and online care services to patients for non-urgent conditions. They have also recently begun doing campaigns to offer vaccinations, school and employment physicals, and health risk assessments required by Aetna and Cigna. Part of their overall customer campaign is a highly user-friendly secure Internet presence in the form of a consumer health record where consumers can do electronic visits and on-line chats with health coaches about common medical issues. What to Do? PCH must make a vendor choice regarding both a patient management and ambulatory electronic health record system. As the practice administrator you have been asked to investigate vendor options and provide an objective analysis to the PCH medical director. He has asked that this analysis include both standalone options and the Epic affiliate option offered by Green Valley. He has asked you to investigate at least three vendor partners and objectively document both the benefits and limitations of choosing each of these options.