Home Forums Discussions General Discussion A suggestion to AC users re: CCHIT

With the CCHIT certification being so onerous on companies like our beloved Amazing Charts, I have written to CCHIT, medical economics, ACP, FTC about the absurdity of fee structure for certification. I would suggest that users of AC think about this (as you are trained to be thinkers), if you feel it is appropriate, so that we the users of AC do not get obsolete, write letters to CCHIT and other forums of medicine/if you belong to other medical organization (eg., ACP, ACS, AGA, AMA etc) the way you feel about this issue.

The links are: for CCHIT first register and then submit public comment-
http://www.cchit.org/comments/register.asp
http://www.cchit.org/comments/comment.asp

For American College of Physicians:
http://www.acponline.org/cgi-bin/feedback

For Medical Economics:
http://www.memag.com/memag/static/staticHtml.jsp?id=109644

https://rn.ftc.gov/pls/dod/wsolcq$.startup?Z_ORG_CODE=PU01

I have enclosed a copy I wrote to CCHIT:
____________________________________________________________
This letter is regarding the fee for CCHIT certification and why you urgently need to change your fee structure and make it easier for small vendors of EMR.

I should say that I don't agree about this certification process just because of what I view as unfair fee. We have been using Amazing Charts EMR for more than 2 yrs, we are happy with the use, the developer Dr. Jon Bertman is a practicing Family Practitioner and is constantly making improvements. We are running a chart-less office (paperless office in common parlance) with Amazing Charts. The program is stable, solid and ideal for small practices.

As I understand it costs an EMR company about $28,000 for 3 yrs and another 9,600 for 2 yrs to maintain the certification process. It costs about $200,000.00 for an EMR company to go through the certification process. These costs will ultimately be borne by public; initially vendors pay, then they pass on to medical practices. Ultimately patients and insurers will pay more, as it will work its way up into payment formulas. This I believe is rather unnecessary and expensive proposition.

Many of the EMRs small practices use EMRs that cost around $1000 (what we use - Amazing charts cost $995.00 for 1 user). The software developer will have to sell 200 copies of software just to pay for this certification process!. This cost will be somewhat fixed for all companies selling EMR. I sincerely hope you will not succeed in your endeavor if your fee is priced as it is now. Your organization may crush small EMR vendors who are doing a terrific job in supporting the small practices throughout the nation. If your main aim is to allow interoperability, then that is already done by many EMR companies in the form of CCR. We have that capability too in Amazing charts. Or on the other hand CCHIT may become obsolete if you keep your current fee structure as only big companies will get certified, pass it on to Physicians, who will totally ignore you as they are not ready to pay those high fee indirectly.

I think the CCHIT certification is absurdly priced, it is not logical in that even the expensively priced ones will have problems on a day to day use as you will find out talking with doctors who use them. I wanted to share my opinion with you regarding what my feelings are and what I think the physicians in USA should do. My opinion and suggestion to doctors in small practices who are contemplating to buy CCHIT products is -- look at the overall cost of ownership say for 20 yrs, or longer if you are going to be around practicing medicine, don't buy products just because they are CCHIT certified. In my opinion it means nothing in running your day to day practice. If you pay $20,000 for just software, close your office for 5 days training to you and your supportive staff, and pay 20-25% support fee per year you will not recoup that money anytime, however you calculate. Many doctors who bought expensive softwares (read CCHIT certified) feel they are stuck with it, as they have already invested heavily in that software and breakups cause a lot of interference in day to day operations.

I also hope CCHIT will not abuse the power it has to twist the arms of Medicare etc to allow only CCHIT certified products to participate in P4P etc.

Hopefully this letter will you some food for thought about your fee. As you have seen already only big companies who charge huge amounts for their software are getting certified by you. I would suggest you visit EMRupdate.com (if you have not done that already) to get a feeling how the physicians and EMR vendors feel about your organization and what you are doing will eliminate the innovation and crush small vendors (This I believe is against the principles on which this great Nation is built upon). And hopefully you will revise your fee structure based on cost of software.
signed----
_____________________________________________________________


Regards.

Way to go Joe!!! You're as rabid as I am sometimes. Excellent letter. Really sums it up very nicely. What this field and country needs is for the small, cooperative, ethical vendors like Jon and AC to be the surviving formate, not GE, Next Gen, Chartware, chart this, chart that crap. We on our side never seem to be able to truely reap the rewards of our own businesses. Everybody see us as an endless supply to "their" money.
As I like to say, "everybody wants to be my friend because my wife is a Family Doc. We are at the begining of the food chain for everybody else, but never ourselves". Pack of vultures.
I don't know if you saw my other posting about; "beware of the Medical Industrial Complex"? It's so true, all these companies and vendors go totally un-price controlled and un-regulated, making money hand over fist, selling products and services to those of us who are some of the most hyper-regulated people in the world.
United Health Care makes record profits, They even bought a bank to make money off of the HRA's they're marketing!!! Welch-Allyn and MidMark Ritter make a pretty good buck. The Pharmacutical industry makes tons of money making "me-too" products with little or no prices controls. Their profit to research ratios are a joke for most of them. Most of these software vendors are making a killing I would hope at 10K-50K per install, along with all those classes and secondaries services that they charge so much for. And you're right about getting sucked in and stuck with a vendor too. It's so hard to try and change EMR's in mid-stream and maintain logic to your filing system. We're still trying to find the right solution to finish that problem ourselves.

That was a great post and I agree that we all need to help keep the "little guys" afloat.

I'm in the process of opening a new practice from scratch and I plan on using AC as my EMR....My question is to all, what PMS are you using? I can't afford to purchase an expensive PMS. Any ideas?

OFFICEALLY plans to offer a full PMS at no charge. But you may have to wait a while.
I’ve been using Office Ally as my clearing house to upload cms1500 claims. Their service is sharp and rapid to respond and they don’t charge the provider or biller for the service- All their revenue comes from the insurance companies.
They tell me it will be a full featured suite of tools similar to Lytec. They turned down my request to beta test saying the product would only be released fully functional and pre tested by the developers. Hopefully available in the next month or so Im going to wait. Since our practice is brand new the load doesnt demand any major puchases yet.

Great letter Joseph2!
We all need to take a little time to squawk about this issue.

“If we don’t hang together we most definitely will hang separately” or “apart” or something like that.
Benjamin Franklin

This office alley thing, is it an ASP, web-based only thing or can one buy and run the software seperate??? Here's why I ask. Just as making the wrong choice on software (ERM or PM) is tough to change out of ("He did not choose wisely") so is choosing the wrong portal or billing company. Remember that most data like this doesn't transfere from one product to the other very well or easily. So, the only product I will buy (and this is my very strong recommendation to all) is one that I can always own my own licensed copy of so I can always control and use the data. He who controls the data wins. We were all ready to go with this really smart experienced lady for billing, but she copped out and went with a virtual only product not a buy a copy of the software product and have her host it on her own server, so we can always own a copy of the same program. So now we would be stuck with that host and their software forever just to be able to look at old data, no less new stuff, get it??? Vendors, products, and corporate cultures change. I want to be able to always put a copy of the software on any computer I own, attach the database to the program and be able to use my data. That's really the key. :!:
I bought QuickBooks and MS Office to run my business and create documents and the like. Once you buy them you always own them and can always use the stuff you created on them and nobody can tell you differently. But these virtual only, ASP hosting type products, you better really like 'em and trust 'em because now you're hitched for life, just to even be able to open up something a year or two old, just for archival purposes. Think about it, you never own a "hardcopy" of the software to run your data...That's just wrong, it's your data. I hope these products that don't sell owner copies die a quick death, they're really a rip. At least design it with a choice in mind.
That was my suggestion to Jon for the AC PM module, that he create a hosting site, but always allow the client the choice of virtual only, or to be able to run your own copy and use it in-house on your own system. Perhaps even require the purchase as an ethical sales thing. "We want you to always own your own copy so you are always in control of your own data, even if you move on to a different product." Now he could corner both sides of this market and come off as the ethical guy he is because he won't make a product that sucks you in forever, just like regular AC, once an owner, always an owner, only the support is an annual thing. :idea:

When we started our own private practice 8 yrs ago after being employed for years, here in Michigan about 800 doctors/practices had a billing software from BCBS Mi called MBA. (I think there are about 14000 licensed doctors in Michigan- part time, full time, self-employed, salaried, Professors, non working etc). The program was very good, served the purposes. They were in market for about 20 yrs (yes twenty yrs). Price was reasonable, monthly fee was reasonable. I heard from BCBS rep at that time that they were billing company with most customers. We bought it for functionality, we were in majority group, what can happen?? Then the standards changed in about 2001/2002. Government brought in HIPAA.

Then BCBS Mi said we can't change the program to meet the HIPPA standards. Overnite these 800 practices were left stranded. We were SCRAMBLING to find one reasonably priced billing company that would suit our budget and so were the other 800 practices. You have to be in that position to understand how hard it is when you are under time pressure, when it is your practice income. With EMR at the least you can go to paper, but with billing? We did find one eventually but that is a different issue. We lost $ 5000 overnite due to change in transmission standards.

The issue here is why you need to be worry about CCHIT. For me the CCHIT motives are suspect.

So I strongly believe the users of small EMR should be really worried about this certification process. Hope this motivates the users of small EMR to take action now (better be early than be sorry in this issue)

http://www.emrupdate.com/forums/thread/56240.aspx

Regards--

I would like to encourage all users of AC to rate AC in KLAS (http://www.healthcomputing.com). While this is not a certification, it does allow USERS of a system to rate it. Currently, you cannot receive a report on AC from KLAS because they claim they "haven't verified an installation and don't have enough respondents."

Perhaps this will provide some small counterbalance to the expensive certification providers. You must remember, the folks who do the certification are really out to make money by having the manufacturer go through the certification process. The folks who do the Klas survey seem to try to make money by selling moderately priced reports or subscriptions. So it won't cost anything to provide a basic rating of any software tool that you use.

"Beware of the Medical Industrial Complex".
We need to stand up as a unified group of small guys and point out all the greed and waste that is everywhere around us. We have been lax and allowed the other side to lable us as the problem. The "fat" on our side, especially in primary care, disappeared years ago. but all these other guys keep bellying up...and nobody calls them on it.
We wrongly argue about buying drugs from Canada, they're not the USA's pharmacy. The issue is that we here are doing nothing to control these greedy multi-national companies. What they absorb is real money forever lost from real healthcare, for real patients and providers.
As an old media guy, I see and feel that the medical community frequently shoots itself in the foot, alienating our patients and the nation when we fight for issues that seem to be more self serving than in mutual interest. Yes tort reform is a real issue, but I think it turns the public against us. FIRST we need the public firmly on OUR side. We on the provider side really need to do a better job of presenting and aligning ourselves with our patients, the entire population of the country. Then we can have the strength in numbers to leverage back. Then someday in the future we can win a battle like tort reform. But today if we can have our patients understanding the issues and that we need assistance in being able to access and be properly paid for taking better care of them, they will be our allies, then we can win almost any issue. But it starts with a dialog that is mutually beneficial and feels more in tune with their needs as well. That's the ticket. :idea: