Two studies were published in the Archives of Internal Medicine this past Monday showing "The risk of cancer associated with popular CT scans appears to be greater than previously believed".
I originally read this article in the WSJ and they included a nifty graph showing the increase in CT scans over the years (1993-2006, and included projected 2007 numbers). I can't say I was shocked. Obviously there will be an increase, population increases year over year.
As expected, the American College of Radiology (ACR), released their own statement in response to the recent studies. The ACR statement was wonderfully put together and basically stated that if an imaging center abides by the standards put forth, then there should be no increased risk as the benefit of the scan outweighs the risk. Seems like common sense to me.
This is where I believe that patients need to take more responsibility for their own health by asking questions instead of just going along with whatever their physician says. After all, when you break it down, its a business that strives to make a profit. I am not putting down all clinicians who perform CTs, I am putting down the clinicians who abuse the system to make the money to pay for their fancy state-of-the-art equipment. Those machines come with a hefty price tag and the ROI must be met somehow. Some clinicians go about it the right way, others don't unfortunately. They are human after all.
Now for the other issue with this...clinicians have to protect themselves. If a patient comes in complaining of a mild condition that a CT may show, its up to the doc to determine the severity of the situation. This is a very fine line due to the liability involved. Unfortunately we live in a world of money hungry individuals who are willing to sue if their coffee if too hot. This is where the relationship of the physician and patient comes into play. There has to be a level of understanding and trust for the situation at hand.
Personally, I have a wonderful relationship with my GP and others specialists that I see because I feel comfortable with them. If you don't feel comfortable asking the hard questions with your provider, maybe its time to look into a different one. Good ones are out there, more good than bad fortunately for us. But it is up to us to sift through the population to find one that fits best. Unfortunately for doctors now a days, it is getting harder and harder to make money and that is unfortunate because I believe that some of the "good" docs may be susceptible to becoming more focused on business side rather than patient care, which I can't say I don't necessarily blame them, they have bills to pay too, big ones like student loans, salaries, mandatory EMR adoption etc.
Now for my cynical comment....I wonder which diagnostic test or treatment or whatever will be next to take some heat in order to cut healthcare costs? Keep in mind this is at the expense of the public who desperately wants change, but I have to ask, at what price? So far it has been more about money than human lives.
Wednesday, December 16, 2009
Friday, December 11, 2009
National Consortium of Breast Centers just announced stance on new Mammography guideline changes
The National Consortium of Breast Centers (NCBC) has just released their position statement regarding the recent mammography guideline changes:
The optimist in me at first said that with these changes, maybe techniques and other medical procedures will be forced to improve based on this change. I still believe this will be the case, but does one outweigh the other? The best approach would be to do both of course. Maintain the guidelines that have been proven effective through various published trials, and allocate ARRA funds to increase R&D of new treatments or improved quality of current techniques. Who knows, there may be money left over from the HITECH stimulus funds by ARRA if physicians are unable to collect the 44k in order adopt EMR.
Once improved procedures allow for a change in the guidelines, then the change is warranted. If not, guidelines should not be altered.
The National Consortium of Breast Centers (NCBC) is currently the largest national organization devoted to the care of Breast Disease. Through their quality measures program, the National Quality Measures for Breast Centers™ (NQMBC™), breast care centers have the opportunity to collect and standardized data to the NCBC in hopes to improve clinical care of Breast Cancer Patients.
“The National Consortium of Breast Center's Board of Trustees has given their consent to the following position statement reflecting their stand on the issue of mammographic screening, in response to the recommendations made by the US Preventive Services Task Force.
National Consortium of Breast Centers, Inc.
Position Statement regarding the Mammography Screening Recommendations of the United States Preventive Services Task Force (USPSTF)
The National Consortium of Breast Centers (NCBC), the largest national organization devoted to the inter-disciplinary care of breast disease, requests the USPSTF rescind their new position on mammography screening.
The U.S. Preventive Services Task Force (USPSTF) published a paper detailing model estimates of potential benefits and harms to women screened for breast cancer with mammography.1 They provided an updated USPSTF recommendation statement on screening for breast cancer for the general population that alters currently accepted guidelines for women over 40 years old.2
The NCBC opposes the new guidelines as written. We cite specific evidence that screening mammography leads to early detection which leads to improved survival.3 In every country starting population screening, mortality declines coincide with onset of screening, not systemic therapy. These USPSTF models are not based on sound data, namely different denominators in the “harms” vs. “benefits” groups leading to invalid comparisons. Recent data from randomized controlled trials reveal significant mortality reductions evident approximately five years after screening programs were initiated. The reductions in age-adjusted, disease specific mortality (30-40%) since 1990 define screening program benefits not seen in the prior six decades. In the United States, these mortality declines continue at a rate of approximately 2% per year. 4 This mortality improvement counts as a remarkable public health achievement.
In addition, the USPSTF panel (comprised almost exclusively of primary care physicians) did not include breast imaging specialists nor was it represented by any of the multiple other specialists who collaborate to optimize patient outcomes. These specialists include pathologists, surgeons, medical oncologists, radiation oncologists, reconstructive surgeons, technologists, geneticists, nurse navigators, educators and others.
The NCBC does not understand the assumptions used by the USPSTF to value human life. We note the cited literature was selective and failed to acknowledge equally powerful and credible peer-reviewed literature, which supports currently accepted breast cancer screening guidelines.
We would also like to note that quality of life has a significant value, not just survival. It is well established that if we discontinue mammography for women in their 40’s, the cancers eventually detected will be larger, more likely need more aggressive surgery, more likely need chemotherapy and more likely lead to other significant socio-economic concerns.
The NCBC requests input into future guideline development and vows to work with government, scientists and industry to keep the process transparent and keep the focus on the patient. We recommend further efforts target screening, risk assessment, education and awareness regarding the implications of positive and negative screening findings. Funding for further research is imperative and supported by the controversy these articles have generated.
Finally, we note the USPSTF article states, “whether it will be practical or acceptable to change the existing U.S. practice of annual screening cannot be addressed by our models.”1 The NCBC agrees with this comment and finds their screening guideline suggestions unacceptable. The NCBC believes many women’s lives will be placed at risk if current screening guidelines are altered. We respectfully request the Task Force rescind their position on this specific women’s healthcare screening policy.
# # # #
About NCBC: The National Consortium of Breast Centers (NCBC) is the largest national organization devoted to the inter-disciplinary care of breast disease. In keeping with our mission, to promote excellence in breast care through a network of diverse professionals dedicated to the active exchange of ideas and resources including: 1) To serve as an informational resource and to provide support services to those rendering care to people with breast disease through educational programs, newsletters, a national directory, and patient forums; 2) To encourage professionals to concentrate and specialize in activities related to breast disease; 3) To encourage the development of programs and centers that address breast disease and promote breast health; 4) To facilitate collaborative research opportunities on issues of breast health; and 5) To develop a set of core measures to define, improve and sustain quality standards in comprehensive breast programs and centers.
References:
1. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 738-747.
2. November 17th edition of the Annals of Internal Medicine, Vol. 151, Number 10, 716-726.
3. Tabar L, Vitak B, Chen HT et al. Beyond randomized controlled trials: organized mammographic screening substantially reduces breast cancer mortality. Cancer 2001; 91: 1724-1731.
4. American Cancer Society, Breast Cancer Facts and Figures, 2009-2010.
All content and design © 2009 by the National Consortium of Breast Centers, Inc.”
The optimist in me at first said that with these changes, maybe techniques and other medical procedures will be forced to improve based on this change. I still believe this will be the case, but does one outweigh the other? The best approach would be to do both of course. Maintain the guidelines that have been proven effective through various published trials, and allocate ARRA funds to increase R&D of new treatments or improved quality of current techniques. Who knows, there may be money left over from the HITECH stimulus funds by ARRA if physicians are unable to collect the 44k in order adopt EMR.
Once improved procedures allow for a change in the guidelines, then the change is warranted. If not, guidelines should not be altered.
The National Consortium of Breast Centers (NCBC) is currently the largest national organization devoted to the care of Breast Disease. Through their quality measures program, the National Quality Measures for Breast Centers™ (NQMBC™), breast care centers have the opportunity to collect and standardized data to the NCBC in hopes to improve clinical care of Breast Cancer Patients.
Monday, December 7, 2009
Leavitt Out, Drummond In?
As usual, its been a busy few weeks in the Health IT world and things continue to get shaken up with many recent announcements.
In a press release on 10/22/2009 the Certification Committee for Health Information Technology (CCHIT) announced that they are seeking candidates to serve as Trustees and Commissioners.
Another press release on 11/13/2009, announced that CCHIT's well known Chair, Mark Leavitt will be retiring in March of next year after 5 years of service.
Once the first press release came through on my feed, I thought it was only a matter of time before this happened. Changes need to be made by the CCHIT to gain acceptance by many skeptics. Then I received the second feed, an interesting decision made by Dr. Leavitt to announce his retirement, especially since the CCHIT has been under major scrutiny lately for being the sole certifier of EMR systems and carrying a rather large price tag, so large in fact that most of the smaller vendors are unable to afford the certification. I'm just not sure if leaving his organization now, especially announcing it, was the greatest business decision for the CCHIT.
The CCHIT has also been accused by it's critics for catering to the larger EMR vendors that also conveniently sit on their Board of Trustees and Commissioners.
I find it quite coincidental that after undergoing such a large amount of scrutiny for favoritism that the CCHIT is now holding interviews to replace some of it's Board Members. I know that you are probably thinking, damned if you do damned if you don't. Thats not where I'm headed. I want to give kudos to the CCHIT and Dr. Leavitt for their accomplishments in the past years as well as the realization, or wake up call, that changes need to be made their board, specifically the board member ratio, which I'm sure will be affected. The positions are open to members of physician practices and hospitals, payers, health care consumers, vendors, safety net providers, public health agencies, quality improvement organizations, clinical researchers, standards development and informatics experts and government agencies. I would imagine that the vendor to healthcare provider ratio will be severely affected.
As for Dr. Leavitt leaving, personally I don't think this is the greatest time the CCHIT during this critical time, especially when the certification business is open for business according to Health and Human Services. Who know's, maybe its a career move...he would be a perfect candidate to head up a start-up certifying company.
That brings me to my next topic, the Drummond Group may prove to be a worthy alternative. They had their own press release on 11/02/2009 that they will submit to become a certifying body. I haven't heard of any progress, but if anyone out there has heard anything, please let me know. For those of us who are new to the Drummond Group, they are a company specializing in interoperability testing. Rik Drummond, CEO of Drummond Group was quoted in the press release saying, "Drummond Group has been supporting Fortune 500 industries and government by certifying the transfer, identity and cybersecurity of their internet information flow over the last ten years. We have also done testing for the CDC, DEA and GSA. Certification of EHR is a natural extension of our testing program, and we believe we can provide great value for the medical community. We look forward to the publishing of the ONC requirements in the days ahead so we can get started."
There seems to be a lot of progress within the Certification realm. My only other questions and worries are targeted towards getting everything in place in time for physicians to get their reimbursements.
Friday, November 20, 2009
Scrapping the Barrel to Support Health Reform?
What a past couple of days in the Healthcare realm. First of all, the Health Reform bill passed in the House with a price tag of $1 trillion. The money has to come from somewhere and it seems like it is coming down to the preventative care of women as for now. In other releases, separated by one day each, new guidelines came out for mammograms and pap smears. Another release just came out regarding a 5% tax on non-elective plastic surgery procedures.
I have to wonder who is influencing these recently altered guidelines and their research findings. I have my opinions on research...data can be manipulated to prove a desired point. I have to assume this is what is going on in these recent releases regarding the preventative care for serious cancers that specifically target women. For the past year I have heard more news to promote preventative care than ever before. Why? Because it saves lives and yes money too. So now, why are they changing these guidelines that promote a higher level preventative cancer? Has anyone thought that the numbers may be down because of the preventative measures that have been in place?
With a $1 trillion price tag, one has to wonder is its to free up funds to pass this bill. Unfortunately, these changes are going to be just the beginning I believe.
As for the elective plastic surgery procedures, in 2008 it was reported that $10.3 billion was spent on these procedures. People choose to get certain procedures to benefit their quality of life in some way, which can ultimately change certain mental conditions such as depression and anxiety which both play an enormous factor in the progression of other serious health factors. Not everyone who elects to get plastic surgery are the typical "trophy wife" getting a different nose every 5 years, its also those people that have little money to pay for a procedure to correct something that may have been caused by an accident for example. Now, these people who have to spend thousands of dollars, that may have had to scrape it together, are expected to spend 5% more. Is that fair to the little girl who was in a car accident and suffered injuries to her face that left her scarred for life without plastic surgery? This is just an example, but it is also a reality of how people are going to be affected by this health care reform push.
I believe something has to change in Healthcare, but at what cost? Certainly not time, after all the current administration is rushing this thing out without the proper time to think of how it will actually pan out in the future.
Its going to be an interesting couple of years to say the least.
I have to wonder who is influencing these recently altered guidelines and their research findings. I have my opinions on research...data can be manipulated to prove a desired point. I have to assume this is what is going on in these recent releases regarding the preventative care for serious cancers that specifically target women. For the past year I have heard more news to promote preventative care than ever before. Why? Because it saves lives and yes money too. So now, why are they changing these guidelines that promote a higher level preventative cancer? Has anyone thought that the numbers may be down because of the preventative measures that have been in place?
With a $1 trillion price tag, one has to wonder is its to free up funds to pass this bill. Unfortunately, these changes are going to be just the beginning I believe.
As for the elective plastic surgery procedures, in 2008 it was reported that $10.3 billion was spent on these procedures. People choose to get certain procedures to benefit their quality of life in some way, which can ultimately change certain mental conditions such as depression and anxiety which both play an enormous factor in the progression of other serious health factors. Not everyone who elects to get plastic surgery are the typical "trophy wife" getting a different nose every 5 years, its also those people that have little money to pay for a procedure to correct something that may have been caused by an accident for example. Now, these people who have to spend thousands of dollars, that may have had to scrape it together, are expected to spend 5% more. Is that fair to the little girl who was in a car accident and suffered injuries to her face that left her scarred for life without plastic surgery? This is just an example, but it is also a reality of how people are going to be affected by this health care reform push.
I believe something has to change in Healthcare, but at what cost? Certainly not time, after all the current administration is rushing this thing out without the proper time to think of how it will actually pan out in the future.
Its going to be an interesting couple of years to say the least.
Monday, October 19, 2009
HIT Stimulus Money: Boom or Bust?
Since the inception of ARRA, there has been mixed emotions of whether or not throwing money at a situation will benefit the struggling incumbent health care system. Having only worked in Healthcare IT for a limited amount of time I believe I can shed some light on the subject from an outsider's perspective rather than a biased, perhaps jaded, insider's view.
First lets talk some basics. Approx $19.2 bill in incentives available to physicians who adopt a certified, meaningful use EMR system. This breaks down to around $44k/provider on up to $64k/provider depending on Medicaid/Medicare patient ratio (the more CMS customers, the higher stimulus awarded). Incentives start this 2010 and penalties start 2015.
The main debates have been lying in the "certified" and "meaningful use" or simply "MU" realms. Let's first talk about certification. The only certifying body to date is the CCHIT which was spawned off of HIMSS and even has a former HIMSS member as its leader. For those of you that are new to this area, the Certifying Commission on Health Information Technology (CCHIT) is a non-profit group based out of Chicago, near HIMSS HQ, that is comprised of different executives who have vested interest in the large EMR vendors...because they run and/or work for them. That is all I will rant about for this post on the CCHIT.
The next big issue, which needs to be radically simplified is MU. Every practice and specialty are different. Meaningful use may vary from specialty to specialty. This needs to be a simplistic model, not a complicated matrix that was originally released, for everyone to understand. There also has to be a lot of gray area as well in this definition to allow for proper payment if a practice is able to show that they use MU.
These 2 criteria, certification and MU, have yet to be decided on. Deadlines are set, but as we all know and have experienced, they may be moved again.
So back to the original question in the title, has the stimulus money caused a boom for HIT or has it been a bust thus far?
Certain areas of the HIT market has seen an increase due to the stimulus funds for HIT for sure, but on the same note, many HIT vendors have seen a lull in sales. Why, when there is at least 44k on the table and adoption needs to happen quickly in order to qualify for the 1st and biggest stimulus handout.
The stimulus money has put providers on a bit of a "wait and see" mentality. There are far too many providers who do not see the value of EMR. Should this stimulus money have been allocated differently? Should more money have went to education and research rather than purchase and implementation?
EMR is not a thing of the future. It is a technology that has been around and in use for over a decade. They have time over time proven effective, efficient and reliable. I am not going to go into detail because the case studies are out there. The only problems that I have seen are due to bad matches between vendor and customer, not the idea or technology itself.
Look at our world now, smartphones that allow us to answer emails while out of the office, telecommuting from home to save on overhead costs etc. Technology will continue to improve upon quality. Be it quality of care or quality of life.
EMR is a way to do both. The incentive from ARRA is there yes, but treat it as a bonus for adopting a new way of patient care and reporting to improve the overall quality of care and patient health for futures to come by adopting and embracing a sound technology that you may, or may not, get some extra cash from.
First lets talk some basics. Approx $19.2 bill in incentives available to physicians who adopt a certified, meaningful use EMR system. This breaks down to around $44k/provider on up to $64k/provider depending on Medicaid/Medicare patient ratio (the more CMS customers, the higher stimulus awarded). Incentives start this 2010 and penalties start 2015.
The main debates have been lying in the "certified" and "meaningful use" or simply "MU" realms. Let's first talk about certification. The only certifying body to date is the CCHIT which was spawned off of HIMSS and even has a former HIMSS member as its leader. For those of you that are new to this area, the Certifying Commission on Health Information Technology (CCHIT) is a non-profit group based out of Chicago, near HIMSS HQ, that is comprised of different executives who have vested interest in the large EMR vendors...because they run and/or work for them. That is all I will rant about for this post on the CCHIT.
The next big issue, which needs to be radically simplified is MU. Every practice and specialty are different. Meaningful use may vary from specialty to specialty. This needs to be a simplistic model, not a complicated matrix that was originally released, for everyone to understand. There also has to be a lot of gray area as well in this definition to allow for proper payment if a practice is able to show that they use MU.
These 2 criteria, certification and MU, have yet to be decided on. Deadlines are set, but as we all know and have experienced, they may be moved again.
So back to the original question in the title, has the stimulus money caused a boom for HIT or has it been a bust thus far?
Certain areas of the HIT market has seen an increase due to the stimulus funds for HIT for sure, but on the same note, many HIT vendors have seen a lull in sales. Why, when there is at least 44k on the table and adoption needs to happen quickly in order to qualify for the 1st and biggest stimulus handout.
The stimulus money has put providers on a bit of a "wait and see" mentality. There are far too many providers who do not see the value of EMR. Should this stimulus money have been allocated differently? Should more money have went to education and research rather than purchase and implementation?
EMR is not a thing of the future. It is a technology that has been around and in use for over a decade. They have time over time proven effective, efficient and reliable. I am not going to go into detail because the case studies are out there. The only problems that I have seen are due to bad matches between vendor and customer, not the idea or technology itself.
Look at our world now, smartphones that allow us to answer emails while out of the office, telecommuting from home to save on overhead costs etc. Technology will continue to improve upon quality. Be it quality of care or quality of life.
EMR is a way to do both. The incentive from ARRA is there yes, but treat it as a bonus for adopting a new way of patient care and reporting to improve the overall quality of care and patient health for futures to come by adopting and embracing a sound technology that you may, or may not, get some extra cash from.
Tuesday, October 6, 2009
Monday, October 5, 2009
Thursday, September 24, 2009
EMR: Buy Now vs Buy Later
This topic has come up in many recent blogs. When is the ideal time to buy an EMR? Is it now so the customer can display meaningful use to get the stimulus money? Should customers wait to find out what the certification is going to be and make sure their prospects will be certified?
Bottom line, the ARRA stimulus "incentive" has inhibited and skewed the compelling reasons for EMR implementation by dangling the 44k per provider. Physicians should not want to implement an EMR simply because of the stimulus, they should want to because EMR systems have proven value over the years prior to ARRA. When implemented and used properly, an EMR can increase patient satisfaction, limit wait times, increase patient flow, improve E&M coding, decrease insurance premiums, increase work/life balance and the list goes on and on.
Someone made a very good point saying that the stimulus money should be more directed to the interoperability of these different systems rather than the adoption. EMR has been evolving for over 20yrs, interoperability is lagging however. Leave the EMR selling to the vendors, we will convey the compelling reasons for EMR adoption, the government doesn't need to sell it by throwing money at it (which it has been doing for all of our nation's problems).
Now the physicians are in a defense mode and uncertain who is telling the truth out there. You have some companies offering financing...are you kidding me? First of all, if you need to finance a system, you can't really afford it. Plus, you are paying interest so the system will cost you more in the long run. You also have some sales folks assuring their prospects that their system will be certified...by who may I ask will certify them? How do they already know this info? Am I missing something here?? I have also heard of vendors guaranteeing meaningful use. MU is up to the customer, not the vendor. How can they guarantee this?
Point is, Customers need to do their due diligence. Research, research and more research. Hire a fancy consultant if it makes you feel better, but don't let them persuade you to a program they think is "cool" or are partial to. Make sure your decision is based off your own and your staff's opinion because you are the ones that will be using the program everyday and your business depends on it.
So should you buy a EMR now or later? The answer is....depends. If you have already done your homework and found a system that completely fits your business model and you have staff buy in, I have to recommend implementation as soon as possible. This way you are ahead of the curve and can even have a better chance of attaining the stimulus money. If you are waiting until all final MU and Certification criteria is completed, you may be behind in attaining the stimulus money, however you at least know the criteria and can make more informed desicions about EMR selection.
Bottom line, the ARRA stimulus "incentive" has inhibited and skewed the compelling reasons for EMR implementation by dangling the 44k per provider. Physicians should not want to implement an EMR simply because of the stimulus, they should want to because EMR systems have proven value over the years prior to ARRA. When implemented and used properly, an EMR can increase patient satisfaction, limit wait times, increase patient flow, improve E&M coding, decrease insurance premiums, increase work/life balance and the list goes on and on.
Someone made a very good point saying that the stimulus money should be more directed to the interoperability of these different systems rather than the adoption. EMR has been evolving for over 20yrs, interoperability is lagging however. Leave the EMR selling to the vendors, we will convey the compelling reasons for EMR adoption, the government doesn't need to sell it by throwing money at it (which it has been doing for all of our nation's problems).
Now the physicians are in a defense mode and uncertain who is telling the truth out there. You have some companies offering financing...are you kidding me? First of all, if you need to finance a system, you can't really afford it. Plus, you are paying interest so the system will cost you more in the long run. You also have some sales folks assuring their prospects that their system will be certified...by who may I ask will certify them? How do they already know this info? Am I missing something here?? I have also heard of vendors guaranteeing meaningful use. MU is up to the customer, not the vendor. How can they guarantee this?
Point is, Customers need to do their due diligence. Research, research and more research. Hire a fancy consultant if it makes you feel better, but don't let them persuade you to a program they think is "cool" or are partial to. Make sure your decision is based off your own and your staff's opinion because you are the ones that will be using the program everyday and your business depends on it.
So should you buy a EMR now or later? The answer is....depends. If you have already done your homework and found a system that completely fits your business model and you have staff buy in, I have to recommend implementation as soon as possible. This way you are ahead of the curve and can even have a better chance of attaining the stimulus money. If you are waiting until all final MU and Certification criteria is completed, you may be behind in attaining the stimulus money, however you at least know the criteria and can make more informed desicions about EMR selection.
Tuesday, September 22, 2009
David vs Goliath
EMR vendors can be broken down into these two categories. In one corner, you have your small vendors whose company size ranges from 10-50 people to include developers, administration, customer support and sales. In the other corner you have the Goliath's i.e. large vendors that have an employee base of over 1000 people.
What makes a customer choose a smaller company over a large one? Does is really all come down to a name? Do people get the warm and fuzzies when they go with a large company?
The main reason why I bring this up is because this scenario is played out consistently with my prospects.
One situation involved a nephrology group of about 25 nephrologists at multiple locations in the Northeast. The sell started out easy. I called in and left a message for the Practice Manager and received a call back the next day...amazing start! (My fellow sales people know what I'm talking about). The PM and I spoke on the phone for a while and I developed a great rapport with the PM as I grew up in the same area and we had some common interests. After the chit chat, we started talking business. I went into the specifics of the application, how it was developed and gave her some historical info on our company. This is where I lost her.
She figured our "small" company couldn't handle the large group she is running with its 24 nephrologists and $2 million/yr revenue. To combat this, I assured her that we were more than capable of handling large practices as we already have large groups in other medical specialties, including a nephrology clinic bigger than hers in which we partnered with to develop the application. Long story short, there was no winning her over. Her mind was already made up. She would rather spend the 100k+ to implement a "Goliath" system just for the name. She even admitted it.
To some degree I can't blame her. We all do it as humans. We want the biggest baddest product we can afford (or sometimes can't afford and buy it anyways). Yes, you get some kind of sense of security, be it true or false. You also get that sense of pride when you speak of your large purchase, vain yet true.
In the sales world when faced with this I have to imagine that this decision is made based on self preservation. It is easier for the PM to sell her decision when she has a branded name to sell. If she mentioned my company to her superiors, they would have no clue based on the name and have to do some work to find out about the company and its product. However, if she pushed a big name "Goliath" vendor, there may be less push back from the ultimate decision makers because they may have heard of the large company through marketing campaigns, tour buses and other professionals in their field. All of this is, of course, just my speculation. Maybe there was somewhere in there where I missed an opportunity and muffed up the sale. She did say however, that our product was probably better than the competition, but she wanted to go with a large company even if it meant more money.
Point of the story?
There are a few....
1. Once someones mind is made up, you have a very small chance of changing it
What makes a customer choose a smaller company over a large one? Does is really all come down to a name? Do people get the warm and fuzzies when they go with a large company?
The main reason why I bring this up is because this scenario is played out consistently with my prospects.
One situation involved a nephrology group of about 25 nephrologists at multiple locations in the Northeast. The sell started out easy. I called in and left a message for the Practice Manager and received a call back the next day...amazing start! (My fellow sales people know what I'm talking about). The PM and I spoke on the phone for a while and I developed a great rapport with the PM as I grew up in the same area and we had some common interests. After the chit chat, we started talking business. I went into the specifics of the application, how it was developed and gave her some historical info on our company. This is where I lost her.
She figured our "small" company couldn't handle the large group she is running with its 24 nephrologists and $2 million/yr revenue. To combat this, I assured her that we were more than capable of handling large practices as we already have large groups in other medical specialties, including a nephrology clinic bigger than hers in which we partnered with to develop the application. Long story short, there was no winning her over. Her mind was already made up. She would rather spend the 100k+ to implement a "Goliath" system just for the name. She even admitted it.
To some degree I can't blame her. We all do it as humans. We want the biggest baddest product we can afford (or sometimes can't afford and buy it anyways). Yes, you get some kind of sense of security, be it true or false. You also get that sense of pride when you speak of your large purchase, vain yet true.
In the sales world when faced with this I have to imagine that this decision is made based on self preservation. It is easier for the PM to sell her decision when she has a branded name to sell. If she mentioned my company to her superiors, they would have no clue based on the name and have to do some work to find out about the company and its product. However, if she pushed a big name "Goliath" vendor, there may be less push back from the ultimate decision makers because they may have heard of the large company through marketing campaigns, tour buses and other professionals in their field. All of this is, of course, just my speculation. Maybe there was somewhere in there where I missed an opportunity and muffed up the sale. She did say however, that our product was probably better than the competition, but she wanted to go with a large company even if it meant more money.
Point of the story?
There are a few....
1. Once someones mind is made up, you have a very small chance of changing it
- Walk your prospect down the right path. You can't make decisions for them, but you can sure influence their decision making during your sales cycle.
2. Know who you are selling to
- This was a large deal for me and I went into it blind, shooting from the hip as they say. I should have already known our short comings and have been prepared to first steer away from them by selling our values and if it came up, be ready with rebuttals. By referring to our large clients and client base, I am able to portray with more validity of how we can accommodate her practice.
3. Sell through the Gatekeeper
- In this case, the Practice Manager was a decision maker but still the gatekeeper. She was covering herself by choosing a big name company because she was given a large budget. If I sold her better right off the bat, maybe she would be a customer today. If I were able to get her on my side and have her be my voice to the ultimate decision makers, then things may be different. Its important to always sell AND educate. Once the gatekeeper has been sold on your product, they can be your selling voice.
Finally, when it comes to choosing an EMR solution make sure it is one that will fit your practice. This goes for price and for functionality. ARRA is giving away 44k to adopt a system. Most large vendors cost much more than 44k so where is the incentive? It's like someone giving me 1 million to put down on a G5, where is the other 58 million coming from?
I know all small companies are not the same, but I have to go off of what I know. (And no, this is not a plug for my company). Most smaller vendors are practically giving their applications away. We are cheaper because we have less overhead....simple stuff. Our company has no marketing dept...we have developers, physicians, surgeons, customer support and sales.
From what I have heard from other physicians who have already implemented a branded EMR, they hate it. There is no customer support, or at least what I have heard is "too little, too late". I'm not knocking the large vendors here, but why would they get back to a 2 physician practice when they have large hospitals to keep happy.
I believe large vendors are perfect for larger organizations. They have the support and can be afforded. In my opinion, smaller vendors have the advantage on large vendors when it comes to smaller practices. There is less red tape and quicker results. Speaking for myself, if a customer calls in and wants a special report done that's not already in our system, it typically takes only a day and costs our customers nothing.
I have heard of implementations taking months, ours takes about 10 days.
In these tight times, people have to do their homework. Ask your vendor the hard questions and be secure in your final decision because once you implement a system, there is almost no turning back.
Wednesday, September 16, 2009
My Very 1st Blog
Well, I finally made it. Feels different but I'm open to change and pride myself on adaptability...eventhough some may say I am hard headed and stubborn. Afterall, it took me this long to start blogging.
My compelling reason to blog? Why HealthIT of all things? My main goal of creating my very 1st blog is to learn. No I am not a HIT guru...yet, however, there are many of you out there and I hope through this blog, I will be able to learn more through others' experiences. I also hope to gain followers like me, who are new to the healthcare industry, and provide a platform for them to speak up, ask questions and learn.
Let's see how this thing goes.....
My compelling reason to blog? Why HealthIT of all things? My main goal of creating my very 1st blog is to learn. No I am not a HIT guru...yet, however, there are many of you out there and I hope through this blog, I will be able to learn more through others' experiences. I also hope to gain followers like me, who are new to the healthcare industry, and provide a platform for them to speak up, ask questions and learn.
Let's see how this thing goes.....
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