Home Forums Discussions General Discussion Status of AC update to version "7"

Saying that given the proper infrastructure, it can be accomplished, but that it is non-trivial for your average practice.

"In the unlikely event ...." we would probably package up the solution so the magic was "in the box".

Jimmie,

If only I could believe your optimistic viewpoint. Practices around me are still dropping like flies. I have not seen anything in my practice to indicate Physicians as primary care will be getting a reprieve. Did your reimbursements go up this year? Mine didn't. Did your overhead not go up? Mine did. Did your taxes go down? Mine didn't. Are your patients more loyal even though you are not going to the hospital anymore? Mine aren't. Are your consultants keeping you in the loop more? Mine aren't. Are your patients stopping in at the drug store mini clinics rather than your office? Mine are. Do your MAs produce more doing ear irrigations than you do seeing a patient with diabetes? Mine do. Do you make more sticking your finger up someone's arse than performing and reading an EKG? I do.
No, I am pessimistic. Every month I find it harder and harder to sustain my practice. There is a lot of talk about Primary Care getting a boost but, honestly, I think the long-term plan is not to pay MDs to do it. I think we have cut off our noses to spite our faces. I said this 15 years ago....Mid-levels will take Primary Care away from us. JMO but hard to dispute.
Will AC survive? Will I survive? Hard to say. But if we do, it obviously will be in a different theater, in a different costume.

It's especially hard once you realize that the commercial insurance carriers are reimbursing about 60% of Medicare. At least in our area. So I am not optimistic either.

Same here, Wayne, and they are reimbursing less this year than last.

60% of Medicare?? How do you survive on that. You should look into forming an IPA and having a "messenger" tell the insurance companies that you will not accept that.

http://www.ama-assn.org/amednews/2003/10/06/gvsa1006.htm

I am confused. Almost all your "no" are my "yes". Medicare reimbursment just went up, about $6-7 on average - I am just getting EOBs. Commercial insurances operate on percentage of medicare so its plus here too. Overhead is less because I am able to get stuff making suppliers to butt their heads. Especially vaccines. MAs are working better because jobs are scarce and they appreciate when they treated well. Patients are more loyal, especially ones who already tried obamacare big hospital chain approach when pcp has 10 minutes per pt, and got screwed up when hospital charges $300 for chest x ray "because you have high deductible". Consultants are much more responsive and appreciative because they are scared to death about shrinking referral base. Taxes went up, but then deductions become more efficient. Thanks to AC I got certified twice now for MU. I am actually ready for step 2 as well. Pqrs is on a back burner for me but I will catch up. I am in solo family practice, north of atlanta.

Bill,

Been there, done that. Being in the home territory of Humana, the medical market here formed an IPA way back in the late 80s, early nineties to negotiate contracts. Worked ok for awhile until most of us realized giving the IPA 2% and ending up with the same contract non-IPA members had was silly so it fell apart. There are no active IPAs currently that function in my market. Plus, as the article to which you refer indicates, the legality of these "messengers" is being investigated by the Federal Government. Actually, I found the article to be more nonsupporting of the concept than supporting. And, by golly, if the insurance company laughs in my face and tells me they dont need me, they really dont need me. They can send their patients to Walgreens miniclinc

Leslie,

What you are saying is going on here too.

Maybe it is the K-cups, the sleep deprivation induced by all of the MKSAP High-Value Care Recommendations banging around in my brain, but I think the tide is turning despite all of the facts suggesting otherwise.
Whether I am right or not, having all of one's practice on a server in his office is a comfort.

Leslie,
We have an IPA here and the FTC leaves us alone because we follow the rules and stay within the limits of the law. It has been invaluable. I can't stand to hear any doctor is being paid 60% of Medicare by commercial carriers. It is highway robbery! Are you sunk without Humana? You can't discuss with other doctors what they are paying you but you can all sure as hell dump them. Unless it puts you out of business, I would send a letter to them and your patients and not tolerate that kind of treatment. $40 for a 99213? $60 for 214? Forget it. You deserve better.

In the past, if your schedule was full, it meant that you were a "good" doctor and you had plenty of money.

Now, in some markets more than others, the referral patterns are being changed and if your schedule is full, you probably work for someone else, and for a lot less. I have a cardiologist cousin in Boston who has had to sell his practice to his primary hospital last year. The times they are a changin.

From our discussions, it seems that there are only two options. You can become a better doctor and you can become a better business. There is always room for improvement, think quality improvement programs. Every problem is a clue that maybe a system needs to be improved, maybe I need to be improved.

I don't mean to pontificate, and to bring the topic back to v7, there seems to be so much room for improvement in the glorified billing programs we use. Getting paid for what we bill with the least staff is important, but to fight in the more competitive market, we need real practice management software. Every successful regional or national business you know has one.

If AC would develop a PM that made it easy to determine the profit/loss for every activity in a typical small practice, it would sell like hotcakes.

I farmed my billing out 3 years ago after a major computer crash but would love to: see a patient, complete my note, code it send the charge and be done. Yes I want AC to get an excellent PM component built in

Do you remember v5?

I would love to: see a patient, complete my note, write a script, send it to the pharmacy....wait, didn't that take 30 or more seconds. Thank God I could send it to the Star printer. Oh...wait, pharmacies don't take postage stamp side scripts.

I am not making fun of you OR AC. It's just that it is so easy for a major bug to happen, months after ePrescribe was running smoothly.

Why?

Easy Rider,

Good posts. Can't agree more. You state that patients are more loyal because they have already tried obamacare, etc.

What about a less than loyal patient who thinks you are the cat's meow, but transfers to the obamacare center only to find out they don't have the same cats. So, they call you up and say we loved you but we only left because it was cheaper.

Take 'em back?

But, Jimmie, what if with all this time and all this user input, AC could tweak what it has now and make it better and leaner. Like when you print a note that you didn't put a RR in, not have it show up.

Different answers to why?

If you have a small practice, is it more profitable to hire a biller or use a billing service?
If you have a biller, which claims should get priority attention? How are they doing against national and regional averages?
If you have a billing service, how are they doing against national and regional averages?
Which plans are decreasing referrals?, authorizations?, payments?
What are the different problems you have with each insurer? Which needs your time now?
Which referral sources are drying up and might need some contact?
How profitable are your "profit centers"? When you consider staffing expenses?
If you are advertising, should you increase or decrease it?

My point is that private practice has been a very sheltered business that is starting to have to compete. Everything was profitable, now we have to worry about making a profit while keeping our lifestyle.

Billing programs are great, but a real practice (business) management program should be using the information entered to show how we compare to benchmarks, the best ways to grow the practice, and the things that need to be changed. It should help with the compromises we have to make on where to spend our time and money managing a business.

Thanks Dan. I guess I am just a pediatrician and not a good business man. They should teach this is medical school and not histology.

If AC will make the perfect PM, on top of some sturdy billing software, we won't have to change the curriculum.

I knew that I wasn't cut out to be a pediatrician when my oldest spent her first six months in the hospital. I thank God for her doctors. But for me, patients shouldn't have parents I have to deal with.

FYI, there is a new Version 7 status update on the Amazing Charts Status Update Board for those interested.

Long story short, it will be a while before AC's PM module is completed because they're starting fresh due to significant glitches in the initial beta version. At least now we know.

Bert,
That would be fine. However, Updox helps correct the dragon induced faux pas (if you catch it) before you send your note/summary to the consultant/patient.

Overall, despite the imperfections of AC, I am optimistic about the future.

One of my partners and I were reminiscing tonight over the 19 years we have been together, and all the transitions the office has gone though. We have both been pleasantly surprised over the past year when most of us have transitioned to AC, and how efficiency has significantly improved. Just printing up the super bill at the time of the encounter, instead of filling out the old super bill with the circles and chicken scratches and missed diagnosis codes, modifiers etc. The AC generated super bill is concise and easy to read for our in house billers, and that alone has been a tremendous improvement. It is the repetitive, boring, mundane, inefficient duplications of the old paper chart world that AC has released me from which gives me the optimism to deal with the finger in the arse compensation. But it is more than that. I am having fun again.

Bert,
Please feel free to make fun of me, I appreciate good humor when it comes along.
Maybe a glitch free PM module integrated into AC is too big of a nut to crack(I remember the days of 3 way phone calls with Lytec/Emdeon/front office arguing whose software change was it that screwed up the billing).
Well I'm not planning retirement yet so in the meanwhile I'll keep asking for it(PM), and anxiously await the Easter Bunny too.

I have never had that type of conversation with Pts. They come and go and come again or not, whatever. They want to see me, I will see them, unless there are some other issues.

<couldn't resist this> ... I actually heard from Santa Claus that the Tooth Fairy told him that the Easter Bunny can be unreliable at times...

Announcement today from the largest primary care group in the county....they are becoming employees of the hospital. There are now only 2 independent primary care docs left. The tide has not shown any indication of turning here.

If my memory of Obamacare is correct, the goal is for the Medical Home model, everyone works for the hospital, which takes responsibility for setting the priorities and guidelines for local healthcare.

The government would rather only deal with the hospital instead of all the doctors. Basically, your income will be based on how politically powerful you are within the hospital, as we will be fighting over the budget for providers.

The hospitals see that they need to start buying up a critical mass of the providers now to get market share compared to other hospitals.

If there is no competition between hospitals and your practice is dependent on hospital access/referrals/procedures, then your practice might not be worth as much later on.

One of our local hospitals recently bought a 95 member physician group -- each doctor got a half million dollars cash. This buyout should be the price point for hospital buyouts of our practices (I wish).

.nwodedispu evruc enis eht ta gnikool eb thgim I

Much of this is based on the ACO, or accountable care organization model. It has been undergoing a lot of revisions as they try to implement it. One of my hospitals has started to implement it and they are NOT buying practices, but they are trying to tie the physicians in tightly around the PHO. The concept ultimately is to get away from a fee for service to a more wholistic, almost true HMO model where you provide optimum care for the patient proactively to prevent spending money on inevitable complications and deterioration. Interestingly, the model calls for keeping patients out of the hospital because that is the largest cost center. I'm not giving away secrets, this is common knowledge. Eventually they will have to see whether this model will be sustainable on a hospital side.

It would appear we are going into another cycle of hospitals buying physicians practices. It's happened before but employed physicians usually are not as efficient as private practitioners. An advantage of a large system is that it can afford infrastructure to follow and bind both patients and their book of business. The disadvantage is that many of us are in private practice after training in large institutions because we saw that the bureaucracies do not work efficiently and we preferred to work for a system we more control.

It will be interesting to see how this all plays out. I do admit that health care costs have spiraled out of control for almost a quarter of a century. But, physicians have not seen much of that increase.

While we are the ones to order the care plan, we follow carefully scripted algorithms (some of the time) that are unlikely to change. Our patterns of care in this litigious society will not deviate without changes beyond the control of the physician. Increasing the responsibility of the patient, decreasing the barriers to health care, decreasing the likelihood of being sued will have far greater impact than hospitals controlling the practices.

It has been a very slow process to roll out needed fixes since V 5 onwards. looks like the team was not upto par to handle the more complex issues incld, PM module, even getting to 6.3 v. This is where AC need to seriously look at integrating an existing software to AC for PM and get done with it rather than promising for more than last 2 yrs. many of us have put off other plans while waiting for AC 7.0. I believe we all have waited long enough by now. Now they have some cash infusion from Pri-Med, I am hoping.

Ravi,

Well put. A lot of us having been saying this for two years.

What about 6.5?
Is that going to be a worthwhile upgrade.
For my part, I am happy with AC and Medware -- not really looking for a combined program until it is well tested.

And in any case, we will still have to use QuickBooks or something similar for general ledger and accounts payable.
Or is all that supposed to be in V7 also?

We have been using AC and Medware for over six years. It's not double entry unless you tell your staff it's double entry. Besides, they get their work done.

You hit the nail on the head. Well tested.

Please post link to Medware.

Total cost of ownership?

Thx.

http://www.jazdlifesciences.com/pharmatech/company/Sage-Healthcare.htm?supplierId=30020144

877-394-6976

Choose sales.

One thing about Medware/Sage/Vitera is there webmaster worked for the CIA/FBI/Homeland Security. To try to find the Medware site, takes a good deal of time and patience. I finally dialed the number above and after a good deal of waiting got a woman on the phone who actually asked me to spell Medware. This is akin to a Microsoft sales person asking me to spell Outlook.

But, once you do purchase, it is inexpensive and support is very good if you hit the right button.

You're right. Website impossible to find. First phone call = busy signal. If it weren't for the numerous mentions on this board, I would never consider them.

I know when I talked to support/customer sales, since I have an ID# and she knows who I am (maybe), I had to tell her I had a prospectice customer. She flew right by that. You would think she would say, "Do you want me to have sales give him a call?"

877-932-6301 # 45240

Laura Zeratsky
Medware Account Manager
Company Sage Software
Business Phone 877-932-6391 ext 45239//813-202-5239

GIVE THESE A SHOT

I wonder if this is the same "Sage Software" that sells Timeslips and Peachtree Accounting. If so, I've not been impressed with their customer service in the past, but I'll give it a shot.

I think I saw that. But, it is inexpensive, rock solid, and once you have a contact in support, everything is fine.

We have used Medware very happily for some time. But, my office manager (who is the person dealing with Medware) tells me she is getting the vibes that support is slowly evaporating.

I've heard the same about Timeslips.