Caritas Christi Health Care System – the largest community-based hospital network in New England – is in the second phase of its EHR rollout. A few weeks ago, the organization completed an extensive nine-week training regimen with its 1,200-member physician group to lay the groundwork for CPOE adoption and proper use of the EHR. Recently, HCI Editor-in-Chief Anthony Guerra had a chance to talk with Rothenhaus about how the current federal policy initiatives were effecting his plans.
GUERRA: Basically, you’re offering unlimited services to these independent practices, at least for a certain period of time. What’s the ROI there? How do you make a business case for that, unless you say that this essentially guarantees the patient flow from these practices?
TODD: Well, you have to be careful with that, no matter who you’re talking to. I’ll tell you the way this works. Here at Caritas, we’ve made a commitment to fund the EHR for our IPA-affiliated physicians to the full extent we can under Stark. We feel that is a critical commitment to creating a cohesive, clinically integrated physician group to care for patients in eastern Massachusetts. I know that sounds a little like an advertisement.
Caritas’ strategy in healthcare is to be a cost-effective provider with equal or better quality than all our competitors. It is a very competitive medical marketplace, so we’re trying to compete on cost as well as on quality, and in order to do that we have to create and leverage IT to be as clinically integrated as we possibly can, so we can deliver on things like patient-centered and medical-home teams. Thus, we have tight affiliations with nursing homes and skilled nursing facilities. We also have our ambulatory practice groups, and we have hospitals. So we’re pretty much in the whole loop of inpatient- to outpatient-type treatment, and what we’re really trying to do is get these technologies to bind everything together. If the systems don’t talk to one another, if they’re not completely interoperable and they’re not actually being used by every provider in our organizations, then it’s not going to work. So, to me that subsidy makes sense on so many levels.
Regarding the long-term support piece, I wish to be clear that the cost of the ongoing support and maintenance is borne by the practice, so we’re getting them started, and I am charging them a support fee. I happen to be more competitive than most of the other groups around me. I undercut them in terms of that. But I already have a data center where we host our EHR customers. I already have a helpdesk, I already have technicians in the field in all of our markets. So it’s very cost-effective for me, and far more cost-effective for me to supply those services than it would be if they went out to somebody else and tried to get a monthly maintenance contract.
GUERRA: Does this, in fact, turn into a revenue stream?
ROTHENHAUS: Well, we’re not for profit. So I’ve costed out my support to recover costs and I’m not making a profit on it, but it is a revenue center. I’m in an IT department that actually has an accounts receivable.
GUERRA: You can make a profit and still be a non-for-profit; it’s just what you do with that money, right?
ROTHENHAUS: Absolutely. I will tell you that we are thinking and talking a lot about offering the same services to physicians who are not in our IPA and for that, we could certainly think about making money. But we have very close relationships with our IPA colleagues, so I don’t feel comfortable making a profit off of those guys.
But you’re right, I could certainly move into adjacent markets and do EHR support. Right now, I have the volume and capacity to do the project plans that we have, but we are talking about expanding because it actually is a pretty cool opportunity for us going forward.
GUERRA: It seems to me that projects like these necessarily mean the CIO’s job at a hospital has gotten infinitely larger than it used to be. You used to worry about what went on inside the four walls, but now it’s so much more than that. Do you think the position has gotten larger than it was a few years ago?
ROTHENHAUS: Well, I wasn’t one back then and I come from a clinical background, I’m a physician. I did electrical engineering as an undergrad and then I became a physician because I thought IT wouldn’t be a way to distinguish myself, but then I certainly graduated back to IT once I started to realize that emergency medicine wasn’t the best way to distinguish myself.
GUERRA: We’ll see what the next phase is.
ROTHENHAUS: Exactly. If I could just work the slopes as a ski guy, I think it would be better (laughing). So I came to the CIO role from clinical which, I think, gave me a little bit of a leg up when it comes to the down and dirty on the project plans for the roll outs of clinical systems, which is what everybody is doing. And I certainly am conversant in all of the clinical technologies.