Home Forums Discussions General Discussion Independent practice partner

Leaving aside any meaningful use issues...

Another internist is starting a practice next door to us. Interest has been expressed by both of us in cross covering, being able to take off blocks of time, etc. He has not chosen an EMR, but is considering AC strongly.

It would obviously be ideal, from a documentation standpoint, to have the patient's records be seamless; that is, if he sees a patient one week, and I see him the next, that it would all be on one system. Is it possible to simply come to some agreement on the sharing of the costs of maintenance of the system and have him buy another user's license on our system? Can he not just print out his own superbills each day and submit them to his biller to be billed with his charges and practice ID?

If I was him, and assuming he's interested and has the wool over his eyes in regard to being married to you, my short-term concerns would be:

HIPAA How safe are my patients?
Backup and IT care of the server and network How safe is my data?
Getting his data if he wants a different EHR How hard is it to get my data?

Sounds like he doesn't have an EHR all picked out and that you could save him a lot more than $1995 in hassle and expenses.

If you are not going to actually merge and have 1 billing number, his AC would have to be on a separate computer system. If you had access to his AC and he has access to yours, you would have to run a virtual OS to have 2 ACs on 1 computer.

We have considered doing something like this since we technically have 2 practices here (one is part-time). But it was too much trouble. The part-time practice still uses paper charts. They just share the office cost and staff costs.

Serene, are you saying that because you have AC linked to a PM (which would require the same billing number), or is it for legal or other reasons?

If the other internist makes up a superbill for each of his encounters, I don't understand why you would need the same billing number. Obviously, he wouldn't be able to link to a different PM, but inputting charges doesn't take to much time for anyone that can 10 key, only a little more work than mailing it to a billing service.

David, if your biller is in-house and not too busy, you might offer to do his billing for a fee with a separate PM

Dan, it's not legal or anything. It's just a computer requirement. I guess if they want to use 1 AC database and merge all their patients it would work - that would be like having 1 practice with 2 providers. But 1 server can host only 1 AC database, and each workstation can open that one database (unless you go the virtual OS route). Sorry if I'm not explaining very well. Some of the more computer savvy users can probably explain it better.

Ok, thanks Serene. I agree they would have to comingle patients, and it would be harder to separate them later. Just didn't want to discourage a new romance.

Does anyone known when Amazing Charts is going to come out with a practice management system?

We really don't know exactly what our future relationship would be, but both of us want more free time, and it might well be that we "job share" but with independent billing systems. We have known each other for a long time (he is currently a hospitalist, but tiring of inpatient medicine), so a lot of what might be unknowns in terms of personality and practice patterns are really pretty well understood by us both. However, we also value our independence in terms of fees and charges and business decisions. The other solution that comes to mind is we each have our own computer systems and our own AC programs, but then buy user licenses on each other's systems and use Remote Desktop or similar to create a record on the appropriate practice's system when we see our "partner's" patient. It just seems cleaner to have one giant database where each encounter is seamlessly listed in sequence in a single chart, no matter who saw him/her.

I think your assessment about sharing databases is your best option. Being able to seamlessly switch patients around is something that can only be done by sharing a database at this time. It all depends on the degree of isolation you want. You have to plan for possible relationship issues. If he decides to leave, how many patients is he taking with him.

The two separate databases with two provider licenses (I would ask AC about their policy on this. They might let you skip on paying for the second license.) Remoting into each other's database would allow you to keep the patients in separate practices and have a continuous set of data. If things were to go sour between you two, each of you has his/her separate databases.

Shared database billing would show the practice name at the top of the invoice. You could of course remedy this easily by adding a custom modifier for each provider and let your billing people know about this in advance. You could also just print them out at the time of the encounter at submit them separately. Using the modifiers/tracked data can be used to keep track of which patient belongs to which provider. Someone skilled with SQL could easily separate the data if something were to bad since he can just look for the provider flag on each patient.

If you want to share on costs like maintenance, virtualization with one server is the way to go. You can maintain two independent systems with one shared cost of the server. But it won't be that large of a saving given two separate systems still need to be configured. There are some misconceptions about virtualization. It decreases hardware costs but not setup costs.

E.g. if a 4 practices want to share a server, you still have to setup each practice individually despite them sharing a physical server. You have 4 independent networks, 4 independent operating systems. I've had people who had a hard time seeing that. You might get a group discount, but the amount of work that has to go into it is about the same.

Or you can of course just add him to your database. So sharing costs is possible either way.

I'm thinking a custom SQL Server Integration Services package could push demographics and encounters to the correct PM system. Keeping demos synched up would be the only real problem as three different primary keys would have to be maintained (i.e. Amazing Charts, PM system one, PM system two).

JamesNT

We essentially do the same thing in our office. We have two legally independent entities sharing all overhead. We share AC, but create different accounts for patients that may have been seen by each of us, thus keeping our records "separate" but allowing us to cross cover for each other.

OK, great. So, some variation of this seems possible, anyway. I'll keep this post tagged as we see what evolves. Thanks so much.