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.
Paul Pitcher, research director at KLAS, says SSI offers good functionality and good support.
In the category Revenue Cycle Transformation, the top spot went to PwC with an overall score of 88.9. Taking second place was Huron Consulting, with a score of 87.0. “PwC has done a nice job delivering good results,” says Smith. “PwC tends to have very good professional consultants and good tools. They’re willing to roll up their sleeves and work with their clients.”
In the category Budgeting, Healthcare Insights again ranked number one, with a score of 87.3, followed by Allscripts EPSi Budgeting, which had a score of 83.9. “Healthcare Insights cares deeply about their customers,” says Pitcher. “They have a strong product, but it’s their service that sets them apart.”
As for the category Claims and Clearinghouse, ZirMed took the top spot with an overall score of 92.5, followed by Practice Insight with a score of 92.2. Dropping from No. 1 last year to No. 3 this year was Navicure with a score of 92.0.
Another tight race was in the category Financial/ERP. Here, McKesson ERP Solutions took the top spot with an overall score of 73.6. In second place was Oracle PeopleSoft Enterprise (73.5). Rounding out the top three was Infor Healthcare Solutions Suite with a score of 69.0. Upgrades are challenging. This is a saturated market and there’s not a star performer. This is an area where providers need vendors to be more proactive,” says Joe Van De Graf, KLAS research director.
Enterprise Scheduling is a very competitive space. In this category Unibased USA RMS was ranked number one with an overall score of 91.2. Epic Cadence came in at number two with a score of 89.3. SSI Solutions Schedule Maximizer took third place with a score of 88.9. “This is a very competitive and tight race,” says Smith. “Unibased USA has a best-of-breed solution but it’s being displaced.”
On the other hand, SCI, which is also a best-of-breed solution, is growing quickly and offers both good support and good delivery, he adds.
Van De Graaff notes that this whole area will continue to grow as consumers assume more responsibility in setting up their own appointments. Adds Smith: “Patient access is becoming a stronger focus for providers as they work to differentiate themselves through good patient engagement on the front end.”
A category that has come into its own and is reflecting the way data is captured and utilized is Business Intelligence/Analytics. Here, QlikTech QlikView was ranked number one with an overall score of 85.6. Dimensional Insight The Diver Solution, which was No. 1 last year, came in at No. 2 this year with a score of 85.5. Coming in at number three was IBM Cognos Enterprise (78.5).
“Providers are looking at measurable outcomes and short-term wins,” Van De Graaff says. “QlikTech’s end users have the ability to interact with information in a very visual way, thus often finding success with defined, short-term projects.” He also notes that “Dimensional Insight has a strong toolset and strong customer relationships.” Speaking of IBM, he highlights a strong toolset, but mentions challenging customer relationships: “Even if a vendor has a robust BI platform, it doesn’t necessarily spell success on its own.” He adds that need for and use of business intelligence in healthcare organizations will continue to grow.
Practice Management software continues to be essential for the efficient running of physician practices. In this category, for practices with 75 or more physicians, Epic Resolute/Prelude/Cadence Ambulatory came in at No. 1 with an overall score of 87.5, followed by eClinicalWorks PM with a score of 77.9.
For practices with one to 10 physicians, athenahealth athenaCollector was ranked No. 1 with a score of 89.5. In the number two spot was Greenway Medical PrimeSUITE Practice with a score of 85.0.
“Epic has always been solid in the billing space,” says Erik Bermudez, research director at KLAS. “eClinicalWorks has struggled with reporting and now they’re starting to struggle with sales and contracting.” As for athenahealth, Bermudez notes: “They were the ones that set the pace. They created the model. And the more a practice is successful, the more athenahealth is successful.”
Systems integration remains a problem for most healthcare organizations, with a lot of functionality being left to the third-party market, Pitcher says. Core vendors appear to be leaving those solutions to third-party vendors. Van De Graaff points to a shift away from long hospital stays and a trend toward more outpatient services and accountable care organizations.
“ACOs really are the framework providers are starting to embrace, reflecting a movement towards value-based care. They’re looking at how to work with and provide care in settings outside the hospital, such as home care and long-term care facilities. Hospitals want to avoid readmissions and avoid unnecessary penalties,” he says.
Morreale notes that his accounting software is not as flexible as he would like, even with the upgrades he has made. “I need a budget tool and a cost-accounting tool and I’ll look for best-of-breed,” he says. In addition, he says taking financial management to the patient level and to the population level will be critical in the coming years.
Podesta observes that CIOs have a lot on their plates right now, like ICD-10, meaningful use, privacy and security concerns, health information exchanges and ACOs. His advice: “Try to get through the next six months. These initiatives can really impact an organization negatively if they don’t work the way they’re supposed to.”