Where Did My Data Go?

Teri U. Guidi, MBA, FAAMA
President & CEO, Oncology Management Consulting Group, Pipersville, PA

There is no denying the trend of medical oncology practices being acquired by hospitals, whether through professional service agreements, employer–employee agreements, or something in between. The 2013 Community Oncology Practice Impact Report1—published by the Community Oncology Alliance—shows that in the past 6 years, 469 (35%) of 1338 responding practices have been acquired, and the rate of acquisition has increased 20% in the 15 months since the 2012 report.

Across the country, educational sessions at numerous oncology-focused society meetings and articles published in oncology-focused journals abound with topics on this subject. The vast majority of these presentations and publications discuss issues such as why a practice should consider acquisition, how an agreement should be structured, how compensation can be calculated, and so forth. Only a few thus far have told the detailed story of what actually happens once the ink on an alignment deal has dried.

When any business owner sells to someone else, there will be significant changes for the previous owner as well as for staff. In the acquisition of a medical oncology practice, this is also true. Staff members will likely experience changes in compensation and performance expectations; physicians will cede some degree of control over daily operations; and payer and purchasing contracts will need to be changed. And, in all likelihood, data systems will change.

The typical medical oncology practice has numerous data systems for insurance verification, scheduling, electronic medical records (EMRs), drug inventory handling, clinical trials, billing, and overall practice management. It is rare that a hospital will simply adopt a practice’s systems. Instead, new systems will be used, and with that comes a subtle change in control for physicians and practice managers who had been accustomed to having complete access to all of the detailed data residing in their various systems.

When a hospital takes over those systems and converts them to different data systems, what happens to the old data? Unfortunately, in the best cases, the historical data are accessible, but difficult to compare with new data. In the worst cases, much of the data are simply lost for good. Let’s explore some of the impact that a hospital acquisition can have on data.

1. The loss of a patient’s scheduling history can be frustrating, al­­though not disastrous, since the information likely also resides, albeit less conveniently organized, in the medical record. Similarly, losing built-in scheduling templates creates headaches for staff members who may have to recreate those in a new system. This is irritating, but not insurmountable.

2. Most practices today have EMRs; however, transferring data from one EMR to another can be very expensive if software interfaces must be purchased. Where interface is not possible, the transfer can be difficult, and there can be a nearly devastating impact: the information may have to be reentered by staff into a new system. The time required to make this transfer is enormous, as staff members comb through the old system or through paper copies and painstakingly enter it into the new system. That time is compounded by what may well be staff members’ steep learning curve for new software.

3. Since most acquisitions include moving a practice’s infusion business, including pharmacy, to a hospital’s domain, losing drug inventory data may not be a huge issue. Still, the hospital’s pharmacy systems often are not accessible to physicians, causing physicians to lose touch with their own utilization of various drugs. This, in turn, can thwart efforts to track adherence to guidelines or participation in quality programs like the Quality Oncology Practice Initiative (QOPI).

4. The loss of the above software system data (scheduling, EMRs, pharmacy) can prove calamitous for a clinical trials program. Data managers may lose all of the data necessary to monitor and report adherence to protocol requirements for physical exams, test orders and results, and treatments delivered. Without this information, compensation from study sponsors could be withheld.

5. Losing historical billing data may not seem, at first glance, to be a concern; however, it may have an impact on physician compensation. While a hospital cannot legally compensate physicians based directly on the infusion revenue that they generate, if the hospital’s staff are not properly trained and skilled in—and the billing system not designed for—the complexities associated with coding and billing for oncology services, revenue may suffer. That revenue is, at least in part, a source of funding for physician compensation and may affect physicians’ total income once an alignment agreement is implemented. In addition, the loss of historical billing data can also hamper efforts to track productivity.

6. Practice management systems are, in many ways, the backbone of a private practice; however, such systems do not generally exist in a hospital setting. Of particular concern is the lost ability to track all work relative value units (wRVUs). In an office-based setting, there are wRVUs associated with technical charge codes for the administration of drugs of all kinds, such as hydrations, infusions, and injections. In a hospital setting, it is literally impossible to attribute specific technical services to any individual provider. Therefore, physician productivity as measured by wRVUs will be lower when the infusion business transfers. In fact, data from the Oncology Management Consulting Group demonstrate an average wRVU differential of 17%. In other words, approximately 17% of a physician’s wRVUs come from the administration of treatments. This must be carefully examined prior to completing compensation packages that are based on wRVUs, particularly if benchmarked against external data.

The loss of historical data of any kind brings with it the loss of the ability to follow trends. Those trends may be as simple as tracking a patient’s no-show history, or they can be as highly complex and important as trending clinical and diagnostic data. What, then, can a practice do to minimize the potentially catastrophic impact of a change in data systems? Obviously, in the ideal world, all of a practice’s data would be uploaded in a perfect format to new systems. But complete transfer of all data is not usually possible.

Therefore, the practice should first be certain to retain access to its existing systems for a reasonable amount of time after a transition. This may result in unanticipated costs for software licenses, hardware, and technical support. Second, consider “printing” all data to electronic files that could be utilized in the dire event of a total loss of functioning software. Software vendors may be able to do this, or the practice may need to engage temporary staff—either way, this step will likely incur unanticipated costs.

Finally, for any practice staff members who will be transitioning to the new systems, ensure that the hospital provides adequate training and support, and that the hospital clearly recognizes that staff and physician productivity will be hampered by steep learning curves.


Reference

  1. Community Oncology Alliance. Community Oncology Practice Impact Report: The Changing Landscape of Cancer Care. www.communityoncology.org/pdfs/Community%20Oncology%20Practice%20Impact%20Report%206-24-13F.pdf. Published June 25, 2013. Accessed November 3, 2014.

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