HMO (Health Maintenance Organization)

Selecting an electronic medical record (EMR) or electronic health record (EHR) for your medical practice is a challenging, but very important task. Purchasing and installing a new EMR system require a lot of research and time. The best EMR software for your practice will fit in with your practice’s workflow and increase efficiency, but a bad EMR will halt your workflow and cause frustrations.

The following best practices should be considered before selecting and implementing a new system, to ensure you select the best EMR for your practice. 

1. Create a list of requirements.

Make a list of EMR software requirements based on the needs of your practice. This list may include the need for e-Prescribing software, automatic billing, scheduling features, and others. Also map out your ideal practice workflow and usual patient visit flow to determine how potential EMR software could complement your workflow instead of hindering it.

It is important to involve all the physicians and staff in your office in the development of this list, ensuring that all aspects of the practice have been considered. However, a physician should be in charge of the decision, not the back-office or IT staff. This decision requires leadership and an understanding of the medical requirements.

2. Analyze your budget.

Purchasing and integrating an EMR system into your practice workflow can be costly. However, the benefits of EMR systems can be worth the financial investment and may even help your practice save money in the long run. Besides the initial EHR / EMR costs, there are hardware, implementation, training, and maintenance costs to consider when purchasing a new system. Find our more about what EMR costs you can expect with a new EMR system.

3. Only consider specialty-specific EMR systems.

EMR software that is designed for your particular specialty is customized to deal with the unique characteristics associated with your specialty. The customization includes specialty-specific features and templates. It is crucial that you only consider software that is designed for your specialty, not software that you need to make adjustments to in order to use. This will help your practice workflow tremendously.

4. Systems architecture.

There are many factors of the EMR system to consider, including the system architecture of the software: web-based or client/server. One type of system architecture is not better than the other, however, one may be better for your particular practice. When choosing EMR software, you will need to decide which type of system architecture is best suited for the needs of your practice and will complement your workflow. Read more about web-based vs client/server EMR.

5. Ensure the EMR System has been certified.

Any EMR system you are considering for your practice should be tested and certified by an ONC-Authorized Testing and Certification Body (“ONC-ATCB”). The ONC (Office of the National Coordinator for Health Information Technology) is the responsible agency for establishing EMR certification standards and certifying vendor EMR products. ONC-ATCB certification assures that your EMR has met required Meaningful Use (“MU”) objectives and measures. This is a prerequisite to obtaining MU Medicaid (up to $63,750) and Medicare (up to $44,000) incentives for adopting an EMR, and avoiding penalties for not adopting one.

6. Get advice from other physicians and staff.

The best way to understand how an EMR system will fit in with a practice’s workflow is to witness it first hand. You may want to visit a practice that currently using the EMR software you are considering implementing. Talk to physicians and the staff about the EMR software to find out if the software would be suited to your practice and what issues you may face with usage or installation.

7. Decide how much support you will require.

Most vendors will offer 24/7 support, but you need to make sure you understand what sort of support you will be receiving. You may need nighttime or weekend support if your practice is open beyond normal office hours. You may also need on-site help instead of help from a call center. Lastly, understand the extent of the support you will be receiving. Instead of just technical assistance, you may want additional assistance installing new features and upgrades, and fixing bugs. Be sure to ask these questions before purchasing from a particular EMR vendors.

8. Have a lawyer review the purchase agreement.

Since purchasing an EMR software is a big commitment, have an attorney review the purchase agreement to make sure the software is what was promised and includes the right features. Also be sure you understand all the costs and additional fees associated with the EMR software purchase.

9.  Spend time installing the EMR system.

Transitioning to electronic medical records takes a lot of time, so do not underestimate the time and effort you will need to put in. Apart from installing new hardware and software, you will also need to manually scan or input existing paper records into the system. Be prepared to hire additional help during this process, as it can be time-consuming and disruptive to your workflow. It is also recommended that physicians schedule fewer appointments during the transition time.

HMO stands for health maintenance organization. While HMOs have been much maligned over they years, they are in fact a great and affordable way to provide health insurance for you and your family. In reality, HMOs provide you with the most comprehensive coverage at the most affordable rates, especially when compared with other private health insurance options.

Usually HMO plans are very structured and have specific coverage networks, often housed “under one roof”. But whether they work in the same building or not -all health care requested under the plan will need to be provided only by the HMO network of doctors, hospitals, and specialists.

How does an HMO work?

With an HMO healthcare plan, you are required to make a fixed monthly payment. This premium acts as a kind of pre- payment for medical services. Within some HMO plans and for some services, there might be co-payments required which need to be paid at the time the services are being provided.
Typically, in an HMO your monthly premiums will not increase during the term the policy is in effect.

Types of HMOs available

Most HMO plans function in the same way regarding the delivery of patient care. The differences are based on structure and composition of their service network:

Staff Model

In this type of HMO, there are a number of specialists who are hired and work at an HMO building. Staff model programs tend to be a little bit more restrictive than the other types of HMOs for both patients and doctors because doctors can only treat the HMO members and the insured can only go to these specialists.

Group Model

Also known as closed panel, this type of plan tends to work a little bit differently because the HMO pays a group of physicians to become their network. Patients under that HMO can only use this group of physicians and the group decides how to distribute the money the HMO pays among them.

Open-panel model

This type of plan allows individual physicians to participate in HMO programs through independent practice associations, that way physicians are able to also treat patients who are not enrolled in HMO programs and are not committed to taking patients just because they are enrolled in an HMO program, providing physicians with a lot more options.

Benefits offered by HMO plans

As mentioned before, these plans offer the most comprehensive level of coverage at the most affordable price. Besides this great advantage there are several other benefits to HMOs such as:

  • Affordable out-of pocket costs: HMO members are required to make a fixed monthly payment regardless of how much medical care they are going to need, in contrast with other types of health insurance that charge a percentage of each medical service provided to you.
  • HMO plans focus on the well-being and preventive care of their insured members. They encourage insured members to practice wellness and preventive medicine. In some cases HMOs offer free health screenings, health educational classes, and discounted health club memberships.
  • HMO health plans do not have any limits on lifetime benefit pay-outs, other types of health insurance often do.

Disadvantages of HMO plans

Although there are many advantages offered by HMO plans, there are some disadvantages that need to be taken into consideration before deciding to participate in one, such as:

  • Limited Network and PCP requirement: these plans tend to be very strict when it comes to specialists you are able to visit. As an individual enrolled in a HMO program you are required to chose a primary care physician (5PCP) who is in charge of your general medical care. In case of a medical emergency, or if you feel you need a specialist, your primary care physician must be consulted.
  • If you are interested in getting services from physicians who are not enrolled in the HMO program, most insurance companies do not cover it. Typically, the HMO plans will not pay for non-emergency care provided by a non-HMO physician. However there are certain types of HMO plans that do allow you to go out of network, for a fee.