Switching EHR's from OffliceAlly to Eclinicalworks: subscribe or buy software?

[heartdoc]

I'm a solo cardiologist looking to switch EHR's from Offlice Ally to Eclinicalworks. Has anyone had experience with the costs?

 

1. BUY EHR OR SUBSCRIBE TO EHR?

A. Buy ECW for $10,000; $1800/yr maintenance fee; $600/yr support; $1380/yr cloud hosting; $1200 to setup cloud; unknown fee for data migration. (done through a third party reseller)

B. Subscribe to ECW for $600/mo ($7200/yr), get free data migration, no setup fee (direct through ECW)

I rather do cloud hosting since I don't want to store a server in my office.

I would take me about 4.5 years to break even using the buy-up-front model vs the subscription model.

 

2. USE THIRD PARTY OR USE ECLINICALWORKS?

Anyone have experience with a third party like Curas that brokers the ECW deal?

 

3. Buy ID card scanner?

Eclinicalworks has an ID card scanner for about $900. Has anyone had experience with this? Does it work for you or too many errors?

 

4. Use 2.9% revenue cycle manager or use 5% biller? 

What is revenue cycle management? I see it on several EHR's. Does it work like a biller that takes only 2.9%? I currently outsource my billing for 5% of collections.

 

 

[PenguinMD]

First: Do you have a good reason to switch? Don't go leaving a "bad relationship" just to go into another one.

Unless you are a group practice then cloud is the way to go. You don't want to invest the infrastructure and staff to maintain it. Plus as you said your break-even is 4yrs out. Tech changes fast so you don't have time to chase it. You just want to pick a solution which has great uptime and make sure you have a solid bandwidth connection.

That being said even locally hosted solution have their issues. How many times does Epic go down at the local hospital? That's a fun day!

Also you may want to pick the EHR that is used in your regional area. If you do clinics at the regional hospital and they also use ECW then it makes things much easier.

That being said there's also many good free solutions out there like PracticeFusion, here's a good link:

http://blog.capterra.com/top-7-free-open-source-emr-software-products/

RCM is just a service for your billing (replaces your biller) for a % fee. It's the new "hot" thing as everyone is chasing services. It use to be practice mgt and then EHR (with MU push) now it's RCM. Think of it in finance terms like a robo-advisor vs a full fledge advisor. Even if you just buy the EHR and PM, expect the sales folks to push you to RCM as that is where they make the most money (kind of like a non-fee advisor who pushes the most expensive funds (or the ones he/she gets the most kick back).

That being said a good biller can be worth their weight in goal, since he/she will know the insurance companies, EOBs, and clearing houses intricacies and nuances. Some RCM is good, some absolutely suck. Probably 80% of claims will get processed no problem, it's the 20% that can be an absolute headache and that's where a really good experienced biller can make a difference. You really need to test any RCM solution before you get rid of your biller. Test for at least 3 months (90d) best even 6 as that will give you an idea how will they handle the exceptions/delinquencies.

The market is really saturated so you should definitely "try before you buy". Switching is not an easy thing so you want to do your homework and find what works and what won't work. The only way you know that is testing out a system for a month or two going through the whole process: chart (notes), fill (Rx/labs), and bill (superbill). Yes this probably means double-charting but you really don't want to paint yourself in a corner with no way out.

Good luck!

Source: in previous life developed and worked on EHRs