If there is a common theme under the various mandates being handed down under the Affordable Care Act, it’s the extreme challenges confronting provider organizations struggling to fulfill the requirements under very tight deadlines. While there has been some breathing space on key mandates—notably the one-year delay on ICD-10 compliance signed into law by President Obama in April, as well as hardship extensions granted by the Centers of Medicare and Medicaid Services (CMS) for Stage 2 meaningful use—providers can be assured that they will feel pressure on compliance for the foreseeable future.
Given those deadlines, clinicians and chief information officers have been working feverishly to upgrade systems, train personnel and/or hire outside consultants, a fact that is reflected in some of the key rankings of the “2013 Top 20 Best in KLAS Awards: Software and Professional Services” report.
“Up until the recent delay of ICD-10, it was consuming a lot of time and resources for providers,” says Mike Smith, vice president of financial and services research at the Orem, Utah-based KLAS. “Many providers were either in or shortly moving to testing and training and education phases as well as hiring additional coding resources and implementing technology such as computer-assisted coding to prepare for the change.” The interest in computer-assisted coding has been so great that KLAS unveiled a new category for this area. In this category there are currently only two vendors with enough clients live on their hospital-based solutions to be measured: 3M and Optum. 3M took the top spot with an overall score of 80.0, while Optum had a score of 70.7. “CAC is still an emerging area, as is evidenced by the fact that only two vendors had enough live sites to be measured. That said, this is changing rapidly, as there are many implementations in process.” Smith says that implementations have been the most challenging area for both vendors, in part because there are so many underway.
When it comes to patient accounting systems, Smith explains that with changing reimbursement models, CIOs are taking a more holistic approach when shopping for new solutions, and are looking for systems that can tie together their inpatient and outpatient billing environments. In this category Epic took the top spot, while QuadraMed and GE had the second and third highest scores, respectively.
Joe Van De Graaff, research director of analytics at KLAS, adds: “ICD-10 is demanding a lot of focus and attention. A lot of people are starting to do remediation now.”
Chuck Podesta, senior vice president and CIO at Fletcher Allen Health Care in Burlington, Vt., says he’s already begun upgrading his systems for conversion to ICD-10. “We’ve done a preliminary upgrade and we’re going to do a clinical go-live on July 1 so we’ll get a read three months before the [original 2014] deadline,” he says, adding that “We’ve also implemented computer-assisted coding.”
Since Fletcher Allen uses Epic’s EpicCare Inpatient EMR, that company has been assisting physicians with the conversion, Podesta says, but he has also called in KPMG to “help direct us and guide us.”
Daniel Morreale, vice president and CIO of Riverside Healthcare System/St. John’s Riverside Hospital in Yonkers, N.Y., says he is concerned about ICD-10. “It’s going to hurt us, so we’re training our physicians to document better. Our hope is that as it affects their practice, they’ll work with us.”
In an allied category, Medical Records Coding, KLAS ranks as No. 1 3M’s Codefinder, with a score of 85.0. In second place was Nuance’s Clintegrity 360 Coding, with a score of 84.4.
In the category Patient Accounting and Patient Management, Epic’s Resolute Hospital Billing took the top spot in KLAS rankings with an overall score of 88.1. QuadraMed’s Affinity Financials came in second with a score of 81.0, followed by GE Healthcare’s Centricity Business with a score of 77.4.
On the community hospital side, QuadraMed’s Affinity Financials came in at No. 1 with an overall score of 79.5.
“Epic is just consistent,” Smith says. “People like the integration component. They also do a good job delivering what they say they’re going to deliver.”
QuadraMed, which was recently acquired by a Constellation Software Inc., a Toronto, Canada-based company, is older technology, but has a loyal client base, and provides good customer support, according to Smith.
As for Revenue Cycle—Claims Management, SSI Group Billing’s score of 87.0 earned it the first-place award. In second place was MedAssets Claims Management (XClaim), with a score of 82.9, followed by McKesson EC2000 Claims Administrator with a score of 82.3. Dropping to fourth place was Optum Claims Manager with a score of 79.4.