The Birth Center in Bryn Mawr was sorely in need of some updates. Founded in 1978, the nonprofit center near Philadelphia had experienced unprecedented growth in the past three years — nearly 50 percent, according to executive director, Nancy Feldman-Kirsh. But as the staff celebrated the center’s increasing volume, it became painfully apparent that the paper trail it had created — dating back to the Carter administration — needed to go.
“We had the same procedures since we began and they were strangling us,” explains Feldman-Kirsh.
So the solution was to go digital. After raising the funds to acquire the updates, the center began the monumental task of selecting the perfect technology and vendor. Feldman-Kirsh and other practice leaders hired MGMA practice consultant Rosemarie Nelson to guide them through the maze of vendors and techno-speak.
“There are so many options for systems out there and we were really babes in the woods to a large degree,” says Feldman-Kirsh. “[Nelson] helped us narrow the field faster. She interpreted for us — technology people speak a language different from regular people — and helped us understand places where we were confused or needed clarification.”
Negotiations of any type have the potential for frustration and confusion, but negotiating with technology vendors can be particularly stressful. For one thing, EMRs and other IT tools are expensive. For another, the vendors know far more about them than you do. Finally, the stakes are higher for you than for the vendor — it has other customers but your practice is the only one you have. You can’t afford to mess it up.
Ready for some good news? Everything — absolutely every part of the deal — is up for negotiation. You name it, you can bargain for it. The vendors do want your business.
Plus, you’ve got us on your side. Now let’s get to the negotiating table.
Do your homework
For the purposes of this article, we’ll assume that you, like The Birth Center, are buying an EMR. But the negotiating principles we’ll discuss can be applied to other large tech purchases, too, like a new practice-management system.
Prices and financing options are all over the map but you can usually expect to pay a few hundred dollars per month, per user for Web-hosted products, or thousands upfront for the client-server versions. There’s also training, maintenance, and upgrades. It’s no wonder so many physicians in private offices have resisted EMRs so far.
So what’s the best approach to succeeding at this venture? First, do your homework. And unfortunately, many practices skip over this crucial due diligence.
“A lot of times the groups agree to buy and they don’t even read the contract, which is scary because they are basing it on trust,” says Daniel Hughes, managing director of the Claritee Group, a health IT provider. “I feel these practices are at risk because they are not doing the due diligence. That’s why we sometimes over-communicate what our deliverables are, just so we feel they know what is going on.”
So what exactly is due diligence? It’s a careful examination of your own practice’s needs followed by a thorough study of your chosen vendor’s ability to fulfill them. You can’t get a good read on the latter until you clearly understand the former, so make sure you know at the outset of your search what your practice needs to purchase: Do you want an EMR system with or without a built-in practice management system? What kinds of features do you need? An e-prescribing module? A voice-recognition transcription system? Specialists, do you need your EMR to be built specifically for your specialty, or can you consider a more generic system that’s open to modification?
Do you prefer a Web-hosted application service provider (ASP) model, or a client-server product? The former is less expensive month-to-month but you’re only leasing access, not buying a product. An ASP also tends to be easier for small practices to manage because the vendor takes care of updates and any technical glitches, but because they rely on the Internet, they can be slow.
Once you are clear on your goals and think you know which vendor best suits your needs, look outside. That means checking references. Don’t just trust your gut. Questions to ask EMR-users include:
- What were the practices’ needs? Are they similar to yours?
- How long have they been working with this vendor?
- What are some positive and negative aspects they have found working with this vendor?
- Were there any glitches? If so, what were they and when did they happen?
- How responsive has the vendor been to problems?
- If the practices had to make the same purchase again, would the doctors choose the same vendor?
“This is a marriage in two ways — between tool and you and between you and vendor. You have to feel confident that they are solid and have integrity,” says Feldman-Kirsh.
Wiggle around
In addition to doing your homework, be aware of some of the areas of wiggle room you can negotiate into a contract.
Payment terms. Of course everyone wants to get paid — vendors, too, naturally. But how and, equally as important, when you pay them is crucial. Remember, some vendors may have legitimate concerns about not getting paid in full, having been burned in the past. That’s why many vendors will ask for 50 percent upon signing a contract and then 50 percent upon delivery. Unfortunately for you, “delivery” can mean receiving a few discs in the mail for you to install and implement yourself. A better bet is to spread it out so that you hold final payment off until you know the product is working to your expectations.
