In terms of software needs in 2010, what are the important differences in concerns for hospitals/facilities versus private practices?

Industry Experts

• Robert Brooker, Director, PTOS Software, Effingham, Ill
• Bill Cummins, Cypress Product Director, Accu-Med Services, Milford, Ohio
• Ricky Gomez, VP Sales & Marketing, Planetrehab, Lafayette, La
• Derek Greenwood, CEO, EON Systems Inc, Clearwater, Fla
• Jim Hammer, COO, Chart Links, New Haven, Conn
• Charles Lee, National Director - Sales and Marketing, Raintree Systems Inc, Temecula, Calif
• Dan Morrill, PT, MPT, CEO, Hands on Technology Inc, Hindsdale, Ill
• Drew Palumbo, Principal, TherAssist Software LLC, Highland Park, Ill
• Steve Petrie, CEO, SpectraSoft Inc, Tempe, Ariz
• Jim Plymale, CEO, Clinicient, Portland, Ore
• Steve Presement, President, InTouch Practice Management Software, Buffalo, NY
• Gerry Stone, President/Clinical Advisor, The Rehab Documentation Co, Nashville, Tenn

Brooker: PTOS only serves private practices and hospital-owned outpatient clinics. It does not service acute care at this point in time. The main distinction that we see between hospital-based OP clinics and private practices is related to billing. Private practices are lucky in the sense that they can optimize their revenue by handling their own billing. Hospital-based OP clinics are often forced to use the hospital's billing system, which is not optimized to physical therapy. You can try to ask that the hospital billing system be adjusted to your needs, but few have success with this approach. If you are able to handle the billing separately from the hospital billing system, you will likely make more money.

Cummins: There are several significant regulatory changes coming in 2010, and it is imperative that your software provider have the necessary design, development and testing resources to successfully deliver these software enhancements in a timely manner. When selecting a software provider, make sure they are well established and employ rehab professionals that are experienced in your specific treatment setting.

Gomez: Often major facilities have readily accessible support staff to address problems and keep the flow of information moving. However, for a private practice, the cost of retaining a support staff is often not feasible or quite expensive. Also, the aggregated expertise and knowledge of the billing and collection staff at a major facility far exceeds that of a private practice, thus leading to claims being paid faster and better with major facilities. Private practices can attain greater leverage and rival that of a major facility by using a firm that provides both software and billing/collections services.

Greenwood: Hospitals/facilities and private practices have many of the same issues. They both need fast, accurate documentation with integrated billing. They both need easy document management and storage. They differ only in a few key areas. The hospital/facility setting requires a higher degree of software security because of the increased vulnerability of the records due to greater exposure. The hospital/facility also needs software that is more scalable. In other words, a hospital/facility setting can vary greatly in size, so the software must be designed with this built into its basic architecture. In regards to the private practice, this is tough. They need nearly everything a hospital/facility needs except for the cost. Basically a private practice needs a cost-effective, easily modifiable (without an IT department) software package that will help them manage the dataflow with as few employees as possible.

Hammer: Data exchange. Hospital-affiliated outpatient rehabilitation centers must focus on how they will connect to the hospital information system and to local area referring physicians via Health Level 7 (HL7) interfaces. Standards and definition around health information exchange will be critical in the coming year.

Lee: At this time hospital information systems (HIS) do not have software (in-patient) specific for Physical Therapy, OT, and SLP. Unfortunately for the hospital/facility, rehab directors have to use paper or "work around" the application the hospital has implemented. As a result, massive inefficiencies have occurred in the in-patient arena. Conversely, the private practices have multiple options to automate their respective clinics. Raintree Systems has provided an EMR application specific for in-patient rehab departments by interfacing with most of the HIS systems.

Morrill: Private practice systems typically have less access to complete patient data (ie, labs, radiology, physician notes, etc) than hospital-based systems. Many times private practices rely on patients to complete "paperwork" to fill in the missing information. Hospitals may have more patient data and other health care provider information. However, they many times lack the sophistication of private-practice EMR systems. Our suggestion is to find a software solution that allows practice managers to implement, customize, and monitor best practices in their facilities to ensure growth. As software evolves and adoption rates of practice management with EMR systems evolves we will see less difference between hospitals and private practice as we strive for complete patient health records where all the data will be available to the health care providers about an individual patient.

Palumbo: Private practices need to have a closer eye on their bottom lines, referral sources and patient satisfaction because they, unlike hospitals, have a smaller margin of error. A hospital or other large health care facility is capable of generating more revenue and may even be self referring. On top of that, marketing and advertising budgets are going to differ between them drastically as well. So, in effect, a private practice needs to get as much as or more for each visit. An EMR like TherAssist can provide a wealth of statistical information that can allow a private practice to adjust methods as needed; be it identifying those physician's who you would like to boost referrals, examine trends in reimbursement and accounts receivable, or being able to effectively track and display a pt's progress graphically which can improve pt satisfaction. A private practice has a tactical advantage in that it can be more responsive and proactive. An EMR, with all that it can provide in terms of data would be an invaluable commodity for a "David" practice facing a "Goliath" hospital system.

Petrie: It's all about getting paid. Hospitals have the relationships and resources to get paid in a timely fashion; most practices don't. Private practices are going to have to move away from the antiquated in-house billing software model to a pooled, billing network approach in order to thrive in today's harsh payor environment.

Plymale: Hospitals are usually worried about integrating their software with other systems. This is usually not a concern for a private practice. Also, private practices have to do more with less. They get paid less for the same work and are subject to the Medicare cap and generally lower payment per code or visit than hospitals. Finally, credentialing. Hospitals and facilities don't need to worry about tracking credentialing at the individual therapist level. You need to be able to keep track of which payors require credentialing and make sure you keep that in mind when you schedule, document and bill those patients. Our system keeps track of credentialing requirements and even provides for online cosigning and co-scheduling where that is required by the payor.

Stone: One area that our experience has shown is dramatically different is how outpatient therapy services are billed. Private practices are usually much better at tracking their anticipated revenues and working their claims. For them, if the documentation supports the claim and the billing data is a by-product of the documentation (which alleviates underbilling), their revenue cycle can be pretty tight. Outpatient therapy services delivered by hospital-owned facilities, on the other hand, almost always send their billing through the hospital billing department. Once there, billing inefficiencies can be much more difficult to detect and even more difficult to fix. That's not surprising, considering that the billing staff is focused on working complicated, high-dollar inpatient claims. Along comes a $225 claim for line item part B outpatient services, and it doesn't necessarily get a lot of attention-especially if it's rejected on the first claim. When the therapy EHR can integrate effectively with the hospital's billing system and staff, and can provide clean claims, there is a significant opportunity to plug leaks in the revenue cycle.