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This one might be a little longer than some of the ones I’ve been doing in the past. This is a little bit of a case study.

We’ve got a sizeable orthopedic practice that’s doing eight figures in revenue. It has double digits, physicians. It has mid-levels. It also does MRI, physical therapy, X-ray, DME, so a pretty large practice.

They’re using Epic. A large part of the reason for using Epic is that they are connected to a hospital that uses Epic, and that got pushed upon them from a clinical standpoint, as has happened so many times in systems. They’re not attached to the hospital. They’re a private practice, but since the hospital rolled out Epic, all the practices attached to the hospital had to adopt one of two systems or something like that. They took on Epic.

In talking to the practice manager about their reporting, she said that none of the reports answer her questions. She was complimentary of Epic interestingly enough, but when it came down to it, she said; literally, they’ve got thousands of reports. It’s a high-tier system, and “none of these reports answer my questions.” That’s a literal quote. She said they have to pull five or six different reports, isolate all kinds of different information, put them into Excel, manipulate all sorts of things, and then try to give it to and distribute to people within the organization. It takes hours and hours and hours to do that kind of stuff every month. It doesn’t give them all they want.

Epic doesn’t allow you to deviate from what they’ve built and what they’ve done. You have to spend a ton of time just trying to get the information you want, and it still doesn’t work very well. Some of the kind of basic things even that she talked about was, you want to know like “How are you doing today or this month compared to last month or last year?”, I mean, elementary kind of business questions that anybody should want to know. They’re not able to get those kinds of answers.

When it comes to clinical things or individual stakeholders, she said we can’t look at doctor A, for example, their status. If the collections or the charges are down, why is it? Is it because of new patients or follow-ups? They can’t see what’s going on, and they can’t compare prior periods there easily. The charges may look good for a particular month, and we’re in November. The way the reporting is set up, they can’t compare it to many past periods. It’s not compared to a prior year. They want to compare the last five years of November because there’s seasonality, and they want to see how it’s trending year over year for many years. They can’t do that. They can’t look at this quarter versus the last quarter, or the last three quarters, or month-over-month, or year-over-year. Sort of any of those kinds of basic business reports you’d expect to be able to do, they’re not able to do.

It’s not just the practice manager in title. It’s effectively the CEO. One of the docs, I think, holds to that title, but the practice manager runs the practice. She kind of chokes, she’s got all the responsibility and doesn’t get the title, which is common.

Multiple stakeholders are having problems. The doctors aren’t getting the kind of information that they want. Most physicians don’t care about how the whole practice is going. They care about how they’re doing individually because many of the compensation structures are related to what they do individually. They don’t want to know how the practice is doing. They want to know how they’re doing individually, and they can’t drill down to the individual doc level to see what’s going on.

They can’t see, for example, how many cases they did in a particular period, or what MRIs they ordered, or how many MRIs they ordered for a specific period. You want to know what’s collected, month, date. Doc walks in and says, “How am I doing?” You want to be able to say, “You’re doing great this month,” “You’re not doing great this month,” or “You’re down this month compared to last month.” They can’t answer those essential questions, making it difficult for the docs and difficult for the practice because they are under a lot of pressure then, and everybody’s frustrated.

Report Manipulation

Sometimes, they try to manipulate 10 different reports. They can’t do it, and they want to go deeper if doc A is up or down or not performing and another doc within the practice. She even gave the example of three docs who are doing the same thing, but they’re getting way different results. Some are getting more money, and some less some are getting paid faster, some are getting paid slower. They literally can’t drill in and say, “Well, okay, that’s because you’re predominantly on Medicare, and Medicare pays lower but faster” or something like that or “You’re on workers’ comp, and comp pays slowly,” or “You’re having this kind of problem,” “This is the reason why you’re different than doc B.” They can’t get that information. They can’t drill down to that next level to figure out what’s happening or why.

The practice manager is an accountant by training and came into healthcare into this practice, not having been in healthcare, although she’s now been in this practice for about seven years. We’ve known her that whole time. When she came into the business, she wasn’t asking clinical questions. She wasn’t even asking healthcare business-specific questions. She was asking basic business questions like “Why aren’t we getting paid?” or “What’s going on?” or “What about this?”

She acknowledged that you could tell that Epic has a great reporting system. Despite that, this is a data-centric person. This is an accountant. Well, she lives in numbers and likes numbers and likes spreadsheets. She acknowledged that she has not been in the Epic reporting system this year because it’s such a pain. Then, we’re in November. If you’ve got an accountant who likes and lives in numbers that won’t even go into the reporting system that tells you something. That’s an indictment on that. She says it’s just because it’s not friendly and you got to spend so much time just trying to get the information you want.

Billing Manager

They have a billing manager effectively, who tries to take up some of that work, sort of that terrible work that nobody enjoys doing, generates reports, spends hours and hours and hours every month manipulating them and trying to get the information they want. The reality is, she said, they don’t believe they’re ever going to get more than what they’re getting now out of Epic. That’s what they’re dealing with. That’s their life.

She was very, very happy to see what we’re doing because she said what’s out there is not working. This should be simple, and it’s not. To quote what she says, “What Apache is doing now is an amazing thing.”

There is a way to alleviate suffering. There is a way to get the data and the information you want and get the answers to questions. You need the tools to do it. Talk to us, and we can let you know how to do it.

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