CPA Comment on EMR Pricing

In response to my previous post about possibly creating an EMR pricing comparison website, I got a really interesting set of comments from a CPA who’s been assisting their clients in their EMR selection process. You might laugh at the idea of a CPA participating in the EMR selection process. Interestingly, the CPA that I use has also been asked by their clients about the EMR stimulus money and so they were grateful they could ask me some questions.

This aside, I found this person’s comments interesting. I think they also illustrate some of the challenges in EMR pricing and some of the thirst for EMR pricing also. I removed some identifying information and some other comments about EMR and HIPAA. Otherwise, the comments are in tact.

I have been pondering trying to do some sort of price comparison myself, and you’re right, they all differ so it’s tough to just do one basic comparison chart. I’ve seen already how some have things all bundled (ie.Athena, and others do it in separate modules can add on – ie. Greenway)

I have featured remote demo’s for clients to listen/view through our firm so they can avoid the vendor pressure… I thought I would try to get info on others for comparison purposes, but in keeping with the theme… it is just not that easy.

There are a few challenging items for comparison purposes, one of them being support and related costs.
The support/training is many times where the wheels fall off the well-intentioned EMR wagons.
You just don’t seem to get an answer or know the true support/training costs until you have already tied the knot with your new EMR system. If you could get more comparative info on that aspect, that would be very helpful – or better yet, come up with an EMR Pre-Nup.

Another toughy is the interfacing costs
From what I hear a [EMR Vendor] system may charge $30k to interface with another EMR vendor.
The vendors call that “not playing nicely”.
So tack on another layer of subjective complexity to your pricing project.

And yet another cost factor I’ve noticed is what EMR system an affiliated hospital is getting preferred pricing on. There is a hospital by us in an arrangement with [EMR Vendor], and of course advising the outside practice physicians to use the same. I am not to thrilled with this idea, I think there are better products that are not spread so thin in so many markets.

I mention the patient portal separately below as some of my clients don’t seem quite ready for that yet.
They view it as another task and feel could attack it once get the EMR running smoothly.
I know they need it for MU [Stage 1 doesn’t require this, but future stages probably will], but they seem to want that a little later than sooner.

In any case, I think some possible approaches for a comparative pricing schematic would be to have different scenarios:
a) 1-5 Docs & Midlevel providers /Web Hosted/ EMR only/ PM Interface/ No Patient Portal
b) 1-5 Docs & Midlevel providers /Web Hosted/ EMR only/ PM Interface/ With Patient Portal
c) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ No Patient Portal
d) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ With Patient Portal
e) 1-5 Docs & Midlevel providers /Web Hosted/ EMR & PM Bundled/ With Revenue Cycle Mgt/ With Patient Portal

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

11 Comments

  • I agree that training implementation costs such as training are largely unknown until after selection. For example, I always ask if there is a local person who can train, etc., rather than making the buyers pay for travel,etc.

    More to the point on pricing our service, ehrselector.com tackles the question of price comparison two ways. First we ask:

    Pricing: First year, software only, price for single MD practice. We do this put the vendors on an equal footing.

    The second thing we do is ask about the target practice size. That is, solo, small, medium, large and we list the size bracket for each. We felt that this was the best way to help in the search for a system by price and practice size. It excludes implementation cost due o their wide range. It’s not that implementation costs are unimportant. It’s that there is no way to build a useful tool to put them on a good, up to date and comparable basis.

    One other problem with building a price DB. The vendors, I have found, are quite willing to tell you their specifics including costs. Even so, there are many problems such as:

    o License types. Some charge per user, some per seat. Some charge only for the site, while others by type of user, that is practitioner v clerical.

    o Maintaining Current Prices. Getting to the right person with the right data is extremely difficult. We have about 40 vendors who subscribe to our system. Keeping them up to date is a major task. The biggest problem is the incredible turnover in personel. The EMR/EHR personel market is extremely volatile. People move up or out and leave nothing for their successors, so I have to reeducate the new person — if I can find them in the company phone tree — who may be gone in six months or less, etc.

    I applaud your idea, but I implore you to keep it simple and try to bribe, excuse me, a way to give the vendors an incentive to keep it up to date without your resorting to a full time staff of several.

  • Carl,
    I guess I’m not as concerned necessarily with the data always being updated. Sure, that would be great, but the posts would have dates on them. Maybe it needs a disclaimer: This pricing was true as of and may or may not have changed. Use this information as just another data point on your search for your EMR.

    It seems that I’m unlikely to maintain a DB of pricing information since there are too many wrinkles. However, the idea of publishing as much pricing information as can be found for as many vendors and doctors as will share seems like an interesting idea to me and something that I think many would find useful.

  • John … Could have sworn you wrote last week:

    “Usability is going to start to trump features as a provider differentiates the various EMR software.”

    https://www.healthcareittoday.com/2010/10/04/future-emr-differentiation-will-be-usability-and-not-features/

    Cost depends on too many individual factors. No EHR/EMR vendor is going to argue price as a differentiator. Price dialog just commoditizes a product or service. No way should a vendor in a developing sector allow the conversation at this point to be about anything other than how adoption enhances the practice owners’ quality of life, its business viability, or its clinical output capacity or quality.

    There is a very important business negotiation tenet: ‘He who defines price first … loses’.

    Carl is right … too many factors that affect the cost … and any good vendor will find a way to make price not the factor.

    If a vendor finds out that a prospective client is not committing due to price then they have won. All they need to do then is ask “what are you willing to pay for this solution?” … then they simply extend the payout over a longer period to lower the initial capital outlays … or they change the mix on the training component term … or how the seats/sessions are accounted for.

    Once a client wants the product … then getting the deal signed is easy … all you got to do is figure out how to spread the cost.

    So focus on what you realized last week … usability is the key.

    Remember … the reason that Brit PCPs adopted EHRs without any government incentive was to make it possible for after hours clinics to cover for them at night or the weekend when the PCP was not open. NHS made 24 hour service a prerequisite for their contracted PCPs … so EHR adoption was a no brainer. Otherwise those PCPs would have had to provide services to their assigned patient population on their own 24/7.

    Had nothing to do with price.

  • Usability is going to trump features. However, that doesn’t say whether usability and/or features trumps price or not. I’ll have to think a bit more about whether is will trump price.

    My initial take is that price matters. Maybe if the numbers are exposed, then it would matter less. In fact, that in and of itself is a great motivation to be sure that EMR vendor pricing numbers are public information. However, I think price is still very important.

    As I once read on a Venture Capitalist’s blog, “Even rich people like to feel like they got a good deal.”

  • Go ask the docs which is more important. If all the packages offer the same features … it will absolutely be about usability. Not price. Go ask. I guarrantee it.

    Ask the docs … “How much would you pay for an EHR which …

    1. Gets you out of the office at 4:30pm every day …

    2. Results in 100% insurance reimbursements

    3. Captures perfectly all your exam and diagnosis notes and tracks patient demographics against potential high risk life styles … and potential for liability risk

    4. Automatically captures all work activity that is not billed or not billable in order to generate recommended changes to next year’s contracts.

    Some docs will brag about how little they spent … and others will brag about how much they spent … but the longer conversation will be about how the acquisition improved THEIR quality of life.

  • Seems like all of your list is still about price. It’s the other end of price, but it’s still about $$.

    Of course, the reality is that it’s both. A usable EMR at the lowest cost possible.

  • How are any of my examples about price? You’ll have to explain.

    Getting to leave reliably at 4:30pm … means you can get in 9 holes with your son before dinner or get to watch your daughter’s volleyball practice.

    Capturing more revenue for the work you do … has nothing to do with price. If work is done for free… it has no value. Sorta like writing prescriptions has no value to physicians … because they are not paid to write script. So why invest in something to improve something you aren’t paid for?

    Written records are the legal standard … automated electronic records must provide a higher level of liability defense than written record. This has nothing to do with cost … it reduces legal costs and protects future revenues… and improves the practitioner’s quality of life.

    Capturing unbilled work … defines what you are giving away for nothing. Can either then charge to good will, charity, or go change next year’s contract. Like in dealing with the pharmacist … when you do work without revenue implication … that work has no value … by definition.

    Seriously … for the doc … EHR adoption should have nothing to do with cost. No matter the carrots and sticks (artificial revene and artificial cost) … if it doesn’t postitively change quality of life … it ain’t really happening.

  • That’s why I said it’s the other side of price…which is decreased costs or increased revenue.

    -Leaving reliably on time assumes that you’re doing so without hurting your revenue. That’s not losing revenue

    -Capturing more revenue for the work you do – Increase Revenue

    -Perfectly captured notes and High Risk tracking – This is the only one not related to $$. Although, you could argue that tracking these things will bring back patients for more procedures which can increase revenue.

    -Capture unbilled work – Increase revenue

    I’m deliberately focusing on the cost, revenue, and price in these comments. It’s not meant to portray the various motivations of all docs. However, I think it’s a mistake to shy away from the fact that being a doctor is a job and the all important dollar plays a major role in it. That’s not a condemnation by any means. They should consider all the price, cost and revenue issues related to an EMR. They are after all a small business.

  • I understand what you are saying John … I simply believe that physicians value their time differently than you think they do.

    The last part above may be all correct… but isn’t really relevant. If an EHR delivers what the vendors and ONC says it will … then for the practitioner the upside reasons why physicians adopt an EHR is for positive quality of life and improved revenue reasons.

    EHR choice has much less to do with cost than the postive factors of features and most importantly useabilty. Given the positive features improving the practitioner’s quality of life … ethereal clinical quality or efficiency improvement are meaningless jabber.

    A practitioner who is concerned about cost above features and usefulness … would be better off to not make the purchase at all because it means that they are paying more than the actual or perceived value they will gain through adopting an EHR.

    The low percentage of practices that have adopted EHRs shows that you are not alone in misunderstanding the full rationale for whether a practice will implement an EHR.

    Some of ONC’s prized academics probably just think they need to come up with a harsher stick to get more PCPs to adopt.

  • For a pricing comparison website, see http://www.ehrcompare.com The site offers reviews of many software programs in most areas of healthcare. Select the Compare menu for pricing comparisons. It is done similarly to the suggested categories above.

    Bottom line: pricing comparisons are not simple questions with pat answers. Pricing should be a final not a first consideration. Shopping by budget is like searching for the cheapest investment you can find.

    Sites like the one above also fall prey to marketing. The programs atop the list are simply those whose users have given the most reviews – a far cry from actually being the best.

    Best pick EMR for any particular healthcare environment comes down to:

    1. Does it drive business to a higher level?
    2. Does it drive clinical care to better patient outcomes?
    3. Will the underlying technology platform go the distance as Certification and Meaningful Use requirements ramp up? (Clinical Decision Support will become a deal-breaker for many existing systems that offer basic types of CDS today but cannot incorporate the more advanced types coming in stages 3 and 4 MU Certification.)
    4. Is it a fully integrated solution for all areas of the practice or organization – one database? (EMR can no longer be a separate system from practice management, imaging systems, document management, business/clinical analytics, etc.)
    5. Can I work long term with this company as a partner? In the end, it’s about relationships too.
    6. Can I see potential for the software to pay for itself over time by helping me build a better practice and raise the bar on my clinical care?

  • @aj … excellent post!

    I tsill would add…

    7. Does it get me out of the office at 4:30pm (improve my quality of life)?

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