Winds of change swept across the healthcare landscape last year, ushering in the Affordable Care Act (ACA), and fueling renewed interest in accountable care organizations and ICD-10 coding.
The scope of these changes has put more emphasis on financial and accounting software, as providers continue to grapple with the important challenge of integrating clinical and financial data. And the importance of business solutions is reflected in the “2012 Best in KLAS Awards: Software & Services” report.
Rankings in this report are based on feedback solicited from providers who use the systems and services. KLAS then assigns a numerical ranking based on overall satisfaction with each product or service. However, the researchers at KLAS also stay in touch with vendors so they are aware of any changes in management or underlying technologies.
In looking at those vendors that offer financial and accounting solutions, Mike Smith, general manager of financial and services research at the Orem, Utah-based KLAS, says he’s paying particular attention to revenue cycle vendors. “McKesson had a course correction. They discontinued their Horizon revenue management product, even though they have a lot of customers with legacy systems,” he notes.
Another major player with a large client base is Cerner. But its product is becoming more of a patient accounting solution, Smith says.
This is partly due to vendors needing to meet market demand, he says. “More providers are thinking about their inpatient and outpatient strategies and are looking at their enterprise. In revenue cycle, there are a lot of old legacy systems—25 to 30 years old—so they’re updating their patient accounting systems.
But Smith also notes that he’s seeing more integration, as providers are opting to purchase new electronic health records and patient accounting systems from the same vendor.
In its latest ranking of patient accounting and patient management software, KLAS again gives the first-place award to Epic’s Resolute Hospital Billing. In second place is GE Healthcare’s Centricity Business, followed by Allscripts’ Sunrise Patient Financials. “Epic continues to do a good job executing and managing customer expectations,” Smith says. “And we’re watching GE closely. They’re looking at opportunities in the marketplace and investing more in their patient accounting software.”
On the community hospital side, McKesson’s Paragon Financials was ranked No. 1 which, according to Smith, is attributable to this vendor’s support of its Paragon line of products. “They have a good HIS solution and are competing on the integration side,” he says. Coming in at No. 2 is QuadraMed’s Affinity Financials, followed by CPSI Financials.
In the category of Revenue Cycle-Claims Management, KLAS ranks SSI Group’s ClickON Claims Editor No. 1—a substantial rise from last year’s fourth place. Jumping from No. 6 to the second spot this year is OptumInsight’s Claims Manager.
Smith says SSI Group has continued a steady rise in the rankings, moving 10 points over the course of five years. And OptumInsight has remained a solid competitor that delivers on client expectations.
In the category Revenue Cycle-Contract Management, KLAS awards the top spot to MedAssets’ Contract Manager. In second place is McKesson’s Pathways Contract Management.
Building IT Bridges
Chuck Podesta, senior vice president and CIO at Fletcher Allen Health Care in Burlington, Vt., says he uses GE Healthcare Centricity Business for his revenue cycle solution and will be upgrading to the latest version in the next couple of months. His organization’s electronic health record (EHR) solution is Epic’s EpicCare Inpatient EMR.
While he agrees that GE Healthcare has invested a lot in its business solution, Podesta says he still needs to use a third-party interface engine to link the financial side of the hospital to the clinical side. The integration of that data will become even more important as providers make the transition to the new ICD-10 coding system, and increasingly move from a fee-for-service payment model to newer payment models involving various forms of episodic bundling and capitation, he says.
In assisting healthcare organizations with their revenue cycle solutions, consultants also are ranked by KLAS. In the category Revenue Cycle Transformation, Huron Consulting has moved up from the third spot last year to number one this year. Taking second place is PwC. “Huron Consulting is set apart by the tools they offer, and customers are happy with them,” Smith says. “Huron acquired two companies which gave it the new technology and tools.”
And while PwC remains a strong player, it has shifted its focus to ICD-10, he added.
The transition to ICD-10 coding, although delayed for a year, has prompted KLAS this year to add a new category: ICD-10 Consulting. In this market segment, KLAS awards first place to The Advisory Board Company, followed by 3M, Deloitte Consulting, maxIT Healthcare, PwC and Ernst & Young.
While the debate rages over best-of-breed versus single-vendor solutions, many organizations are finding creative ways to make them more efficient.
Charles Watson, vice president of corporate IT and enterprise business applications at the University of Pittsburgh Medical Center (UPMC), has essentially cobbled together a number of best-of-breed systems using Oracle PeopleSoft Enterprise for human resources, payroll, enterprise resource planning (ERP) and supply chain functions; Epic Resolute Hospital Billing for ambulatory patient accounting; and McKesson HealthQuest for inpatient accounting.
But he says the collection and utilization of both clinical and financial data is now affecting how an organization uses that data. It is, he says, transforming the field of business intelligence from a transactional model to one more seeped in analytics. “Business intelligence is more of a look-back,” he says. “Now we’re looking at data as it happens and predicting what will happen.”
In the category Business Intelligence/Reporting, KLAS again ranks Dimensional Insight’s The Diver Solution number one, followed by QlikTech’s QlickView. In the No. 3 spot is McKesson’s Performance Analytics (formerly Horizon Business Insight).
Smith says Dimensional Insight has gained a reputation for listening to customers and delivering on what they promise. However, it does not target the large health systems, he says.
QlikTech is a company based in Europe that has entered the U.S. Market and is gaining some nice traction here, says Smith. Clients are happy with it and the company offers integration solutions across the financial and clinical spectrum, he adds.
With a new format (5010) for filing insurance claims on the horizon and ICD-10 implementation scheduled for 2014, claims and clearinghouse solutions are becoming a vital part of an organization’s financial environment.
In this market segment, KLAS awards first place honors to Navicure—move up the ranks from last year’s third place. Coming in at No. 2 is ZirMed, followed by Office Ally.
Mark Wagner, director of clinical and ambulatory research at KLAS, says the top three vendors in this category keep jockeying back and forth, but he notes that Navicure consistently performs at a high level. “Clients say they’re getting their money’s worth.”
In addition, the 5010 transition has not been lost on Navicure, Wagner says. It has been running tests using this new format with both providers and payers.
Another important part of a healthcare organization’s financial arsenal, especially during lean economic times, is its enterprise resource planning (ERP) solutions. In this category, Oracle’s PeopleSoft Enterprise holds onto the top spot, while KLAS gives the second place spot to McKesson Pathways Financial/Materials/HP Manager, based on customer ratings.
Yet another area that is growing in importance is enterprise scheduling which allows patient information, including that pertaining to insurance and Medicare coverage, to be acquired at first contact. In that category, KLAS again this year ranks Unibased Systems Architecture’s (USA’s) RMS as No. 1, followed by SCI Solutions’ Schedule Maximizer and Epic’s Cadence.
Paul Pitcher, director of financial systems at KLAS, says Unibased USA remains ahead of its competitors because of the attention this company gives to its customers, making them feel as if they are in a true partnership relationship. The only question is whether it can sustain the growth of its client base, he says.
It goes without saying that patient billing is at the crux of a hospital’s financial health, but often a bone of contention with patients. In the category Patient Access-Patient Bill Estimation, KLAS ranks as No. 1 TransUnion Healthcare’s FHSClearQuote (FHSCorp). In the number two spot is MedAssets’ CarePricer.
As for budgeting applications that can both manage budgets and track variances, KLAS gives its first place award to Healthcare Insights’ budgeting software. Coming in at number two this year is Allscripts’ Sunrise EPSi Budgeting.
Pitcher says Healthcare Insights continues to do a good job servicing its customers. “And they’ve demonstrated a desire to bring in new technology and to advance that technology to address the ongoing needs of their customers,” he adds.
In order to aggregate business-level data, organizations rely on decision support systems. In this market segment, KLAS ranks Allscripts’ Sunrise EPSi Decision Support as number one, followed by Kreg Information Systems’ Decision Support/PLM and McKesson’s Horizon Performance Manager.
Pitcher says that even though Allscripts’ EPSi offering was the result of an acquisition, the EPSi group continues to perform at a high level and has introduced a newer design and newer technologies that appear to be meeting the needs of its customers. And while Pitcher wonders if one of their competitors will eventually dislodge them from their first-place perch, he acknowledges that Allscripts’ EPSi is a very strong player in the area of decision support.
Practice Makes Perfect
As healthcare systems continue to acquire physician practices to bolster their bottom lines, and as physicians consolidate existing medical practices, practice management software is essential for the efficient running of these practices. But because EHR adoption under meaningful use can make or break a practice, these providers must be able to integrate clinical and financial data through an interface between their core EHR and their practice management system.
In the Practice Management category for practices with more than 75 physicians, KLAS ranks Epic’s Resolute/Prelude/Cadence number one. NextGen Healthcare’s enterprise practice management (EPM), which was in fourth place last year, rose to number two this year. Tied for third place is GE Healthcare’s Centricity Business (ambulatory) and McKesson’s Horizon Practice Plus.
For practices with 11 to 75 physicians, athenahealth’s athenaCollector took the top spot, followed by Greenway Medical’s PrimeSuite Practice and NextGen’s Healthcare EPM.
In his analysis of the larger practice solutions, Wagner says that even though Epic’s score is three points lower than last year, “They can lose a few points and still retain a performance lead. There’s stability there and there’s expectation and delivery.”
NextGen rose because of uncertainty over McKesson’s product. Although McKesson has says it is sunsetting its Horizon line to concentrate on Paragon, it also says it will keep this particular practice management solution, Wagner says.
Whether a physician practice or a multi-hospital organization, choosing the right financial solutions will become even more critical as the effects of new federal legislation and industry-imposed regulations become even more evident.
Given the fact that systems integration remains an issue for healthcare organizations and even the most venerable of vendors, Podesta offers some advice to other CIOs who are considering either purchasing or upgrading financial or accounting systems. “If you’re purchasing a new system, go with an integrated approach—a single-vendor solution,” he urges. “If you already have a system, look at the return on investment before integrating because the dollars and risks associated with that are high.”