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Size Matters

August 15, 2016
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When I was a Corpsman in the Navy I sutured a cut on a patient’s left hand. I annotated the chart and indicated that the patient had a “small” laceration on his (L) hand. I later was called into the office of the Doctor that was reviewing the charts. This doctor informed me that the earth is small relative to the universe, and that I should be more precise in documenting lacerations. This advice stuck to me.

Practice management software does not have a consistent definition of what is considered a “small” physician group. When you look across the various practice management vendors, they tend to be ambiguous as to what size physician groups they cater to. The reason is they don’t want to turn down large sales, on the other hand no software vendor wants to talk about response issues with larger clients. Granted when you talk about performance you have to address issues with:

  • Network connectivity, bandwidth and routers
  • Server hardware, data center connectivity
  • Server operating systems, and patch management
  • Virtualization and other applications running on the virtualized server
  • Citrix, connections and setup
  • Desktop hardware, operating systems, patch management and other applications running on the desktop

Compounding all these issues is the fact that Physician Practices are typically geographically disperse. Meaning that connectivity may be a patchwork of circuits and high speed internet providers with varying degrees of quality and reliability. In other words there is plenty of finger-pointing when it comes to addressing issues with performance. Software vendors will try to tell you that size does not matter for their application. So who do you believe?

If your organization is located in the same building all with fiber-optic connections and dedicated server arrays, you can certainly make just about any software work. However, regardless of the resources you throw at an application the chokepoint often comes at the database structure. Practice management systems are all essentially a front-end view that enables users to park information into tables. So we can all understand the difference between maintaining a database structure for a small town government agency versus maintaining a database for Google. So when it comes to physician groups, which one is “small town” and which one is “Google?”

We often hear the terms “solo,” “small,” and “medium” size physician groups. But they are rarely quantified. Obviously it becomes even more complex when you consider primary care physicians mixed with specialty care. So there is lots of variability within specialty groups, mixed physician groups and primary care groups. 

Regardless of the size of the practice they all need the practice management system to perform the same key functions:

  • Registration and Scheduling
  • Scheduling rules
  • Automated eligibility checks
  • Flags and alerts for transaction errors
  • EMR integration
  • Claims Management and Payment Posting
  • Work list and Denial Management functions

Other functions are pretty much designed to meet the same basic workflow. So how do you define the size of physician groups to properly select your core group of vendors that will meet your particular requirements? Here are my sizing categories:

  • Small: 5-50 Physicians
  • Medium: 50-150 Physicians
  • Large: 150-250 Physicians
  • Large Affiliated: 250 and above Physicians

I have a “Large Affiliated” for those physician groups that have been acquired by Health Systems and essentially merge into an Ambulatory Services arm of a Hospital System. They normally use the same vendor the hospital system uses and integrate into the hospital clinical systems.

Based on my sizing guideline you can quickly assess were the various vendors fall in each category. I am certainly not going to categorize the vendors into each size, since I don’t want to get phone calls from vendors trying to make a case for a different category.

One way of selecting the right vendor for your size organization is to understand the history of the Practice Management Systems. How it evolved from either development or acquisition and what are its roots. This will give you a sense of how the core data base was structured and for what size physician group was it designed for. Just because they operate in a certain market size, it does not mean they are a good fit for your organization. For instance, there may be some complexity in your Professional Billing component for hospitalist, anesthesiologist or Radiologist. Some of these specialties are more often their own standalone companies, but still have a billing relationship with your Physician Group. Some of them lack a comprehensive worklist module that allows users to update and run reports without bringing the production environment to a crawl. Others do not work well in an integrated multi-EMR environment and requires remote hosting.

So make sure to account for all these variables when evaluating Practice Management Software. Because contrary to popular belief, size does matter.