I never used to talk much with hospital CEOs. After all, if you’re running a hospital, improving the revenues of the physician practice by 6%, when the physician revenues only make up 10% of your overall revenues, doesn’t really make it to the scheduling screen.

Now it seems that hospital CEOs are the only new people I meet. In fact, I recently had dinner with over 100 of them at a meeting of the Leadership Institute in Washington, D.C. I gave the breakfast speech the next morning…it was awkward.

You see, I’m dying to be liked by these people—all people really—but these are health system/hospital CEOs and CMOs, many of whom are currently thinking about adding hundreds or even thousands of doctors to their payrolls. For a guy who does business services for doctors, who better to be friends with?! And yet, the only thing I could think to say to them was that they were sowing the seeds of their own destruction! I try to be smooth and cool when I get up in front of these groups, but somehow, when the microphone turns on, I can’t keep what’s on my mind from pouring out of my mouth!

I’m not exactly sure how I said it then, but let me try to say it like a grown-up now.

First, these days offer perfect conditions for planting seeds of destruction. Why? Docs fear Barack! Well, maybe not the man himself, but they fear for the near future of their practices. They have looked at EMRs in the past and…well…taken a pass. EMRs can cost a lot of money upfront, successful implementation is not a sure thing, and, on average, EMRs just slow down patient throughput. So a doc who lives on patient throughput finds this proposition to be a non-starter. Now, with new federal incentives, he or she feels compelled to get an EMR. And those who aren’t immediately enticed face future penalties. Add to this the health reform bill which adds millions to Medicaid rolls (not the best payer), and now doctors have compounding fears. They will need to fork over upfront capital for a product that will slow them down, and their income is about to decline.

What’s a doc to do? Same thing they always have done when such a storm is brewing: SELL THE PRACTICE TO THE HOSPITAL! They make the following offer: I’ll sell you my practice on the cheap IF you buy me all the EMR that Barack wants and make it work, AND IF you “keep me whole” on what I am making today.

What’s a hospital to do? DO THE DEAL! Most hospitals are buying practices and promising them EMRs as well as salary subsidies. Regardless of what happens over time, it makes short-term sense to keep OTHER hospitals from buying and re-purposing these practices! Hence we are in a bit of a free agent season where docs are concerned. Primary care docs are routinely getting salary subsidies of over $100,000 per year and cardiology subsidies are routinely exceeding $250,000! This type of free agent season happened in the early 1990s between docs and hospitals. Then, in the late ‘90s when hospitals asked docs to take pay cuts, the docs started complaining to hospitals about the finer points of their billing and management and the mergers broke up. So will it be déjà vu all over again in 2015 when the rates come down and hospitals must ask their newly acquired docs to take pay cuts?

No, I think it will be worse.

In 1990, hospitals didn’t load large amounts of capital expenditure into the deal when they acquired practices. This time they are! The capital expenditure layered onto each doc acquired for EMR software and hardware can be around $50,000 to $70,000! Now add the fact that EMRs generally reduce patient throughput and require “EMR departments” to maintain (up to $18,000 per physician in annual maintenance costs), update, and load the software with clinical data each day.

Lenders are generously offering to finance these expenditures over 10 or 15 years for hospitals. Ever seen a 10 or 15-year-old piece of software? Ever wondered what would happen if the docs and hospitals break up? Do you think the docs in the community are going to use those hospital-based software systems or will they switch to web-based systems that maintain themselves and cost less? If this happens anywhere, that hospital will have to remove the software asset from its balance sheet. IF they do that, they will trigger their loan covenants and freak out their lenders.  If their lenders freak out at a coming wave of hospital defaults, they will tighten up on their other hospital loans. Uh-oh.

So what’s the moral of the story?

Hospital: If you want to remarry your ex-practice-spouse, go for it. That practice has grown up a lot over the last ten years, and this really may be the Cinderella story of integrated care you hoped it would be. All I ask is this: don’t have kids right away! At the very least, think twice before investing millions of dollars in software. Use the power of the Internet (and web-based EMR solutions) instead of large amounts of capital expenditure, so that if things don’t go well and you break up again, you can still be friends.

In case you haven’t yet noticed, a gross sea creature has infiltrated our website. Maybe this slimy beast looks familiar because you just got back from the sushi bar or because one of the same has been lurking in your practice recently.

Vanquish the beast! Crush it with your slightly-too-heavy laptop! The eyes! Go for the eyes! Kill! Kill!

Whoops. OK. Let’s take a deep breath.

This is actually part our new advertising campaign and the OctoBeast is meant to embody the ever-lurking complexity and hassles and slow, costly EHRs that can drag a medical practice down into the murky depths of despair.

Before launching the campaign three weeks ago, we tested the concept with MDs to be sure it spoke to them and their pains. They were definitely intrigued, even startled at first glance but they immediately got it and began to describe the “beast” of payer complexity and government mandates and ANSI 5010 and other creeping threats to their livelihoods and peace of mind.

So rather than resort to cheap violence and risk trouble from HR, the cops or PETA, how about a few laughs? Take a look at this cartoon and put on your comedy writer cap.

Send back your funniest caption(s) in a comment to the blog. You can check out the competition in the comments section of this post and then stay tuned for the October issue of Pulse to see the winning caption. We’ve already had some real zingers come in from readers of the September issue of Pulse. If you don’t already read Pulse, subscribe now for the latest news from athenahealth.

And to learn more about the OctoBeast, check out this video, with our beast tamer-in-chief, Jonathan Bush.

Good luck!

Gone are the days when “open for business” lasted a few hours longer than a 2^nd grader’s school day. Today, meeting consumer demand means being able to interact around the clock and on the web. Banking? Online. Travel reservations? Online. Tax filing? Online.

Can we say the same thing for the health care industry?  I sure would love to pick up my test results online, get a list of my dad’s medications online, schedule an appointment online, pay a bill online, get my child’s vaccination history online, or, well, you get the point.

I’d leap at any available means to avoid calling the doctor’s office.  But the health care industry has fallen behind consumer demand.  In fact, most physician practices today still depend on staff to answer phones or send letters through the mail. To compound the problem, modern physician practices have been saddled with onerous paperwork that keeps providers from spending enough time with patients. 

I’m not the first to point out the tricky balance between providing care and staying in business, as shown by these recent findings in the New England Journal of Medicine.

It doesn’t have to be this way, but over and over again doctors hear the typical complaints from patients about being left on hold or waiting for sluggish test result news.

This is not in the physician job description. Such patient dissatisfaction on top of an uncertain legislative and bureaucratic health care landscape can make physicians think twice about their chosen profession.

This is a company with a mission to make things simpler and better for physicians.  We have to find innovative ways to take administrative busy work out of the physician’s office and allow them to do what they do best—provide patient care. 

Against this backdrop, last spring we launched a patient communication software service called athenaCommunicator.

With this new service, we take on the work of communicating with patients on behalf of physicians. So far, we’ve found that giving patients greater access to their information through the web and proactively reaching out at key moments in the care cycle can actually increase practice revenue, decrease phone calls and reduce administrative burdens. The results to date have been extremely encouraging.

If you want to find out more about increasing schedule density through better communications, register for a webinar hosted by yours truly tomorrow, September 9th. It will kick off at 12:15pm. Join the audience by clicking here and signing up.    

I’d love to hear your tales and thoughts on this subject.  Please send in your questions and ideas by posting a comment on the blog.

Have you seen a slimy, mean-looking octopus lurking around your office lately? Probably not. But don’t be too shocked if you see one surfacing in practices featured in our new “Tame the beast” advertising campaign that we officially kick off today.

The octopus in question isn’t real (no marine life was injured in the making of our campaign), though we hope you think it looks real and sufficiently menacing. It’s actually the deliberate, and at least semi-rational, creation of athenahealth’s content team, our Boston-based creative agency, and the same 3-D animation wizards behind the “Spider-Man 3” movie.

Our beast, and the new campaign it serves as mascot for, is meant to embody the ever-lurking complexity and hassles and paperwork and unpaid claims and slow, costly EHRs that can wrap their tentacles around a practice and drag it down.

Early on, when we showed the imagery and concept to doctors (making sure we weren’t crazy) they were definitely startled at first glance (not a bad thing in the case of an ad meant to grab attention). But almost immediately it provoked a surprising response. They began to describe in vivid detail the “beast” of payer complexity and government mandates and ANSI 5010 and other creeping threats to their livelihoods and peace of mind.

Let’s face it. As we say it in the ad copy, running a practice is getting more complicated – and more frustrating. There are constantly changing rules, rising costs, mounting paperwork. And the reality is, buying and managing expensive software won’t make it any simpler. We think we’ve got a solution that can help “tame the beast” for practices and unleash their real potential for growth and improved care.

So, that’s why an octopus has taken over our website’s homepage and will be slithering into magazines in your office and across banners on web publications. We think it’s a fun, and yes different and somewhat out there way to grab the attention of busy doctors, connect with their pains, and begin a conversation about how we think we can help.

We could be wrong, but we think it’s a campaign that’s got legs…er, tentacles.

Don’t miss this short video featuring President & CEO Jonathan Bush and “the beast.”