Some IPAs Embrace Leading Roles

April 11, 2013

A strong independent physician association can become a hospital chief information officer’s best friend. If the IPA develops its own sophisticated EHR support infrastructure, it can ease many of the challenges of health information exchange. For instance, Taconic IPA in Fishkill, N.Y., has been instrumental in the development of the Taconic Health Information Network and Community (THINC) regional health information organization (RHIO) in the Hudson River Valley. Taconic IPA was one of the first physician organizations in the country to lead a RHIO effort.

At a recent World Congress event in Washington, D.C., Ginger Lyons de Neufville, executive director of 500-member Mount Auburn Cambridge Independent Practice Association (MACIPA), described the growth of her Massachusetts-based organization’s project team as it gains momentum with physicians interested in meaningful use. MACIPA was founded in1985 to organize physicians and negotiate managed care contracts. Starting in 2006, it began partnering with the 191-bed Mount Auburn Hospital and electronic health record (EHR) vendor eClinicalWorks on an effort that today supports 156 physicians and 784 total users. Each implementation takes from 12 to 16 weeks from inception to the “go-live” stage. Physicians pay for practice hardware and an annual maintenance and support fee for the EHR.

All other EHR expenses are paid for by MACIPA, which has built its own data center to host the software and increased its support staff from two to 17 employees, including help desk, interface developers, data center support, and account management staff. An EHR optimization manager who is a registered nurse and has experience working for a quality improvement organization oversees the training and ongoing support. “One key to success has been formalizing what was an ad hoc EHR committee into a standing IT committee to work on issues such as patient consent policies,” said Lyons de Neufville. “It is a physician-led standing committee of the board." MACIPA hired an assistant medical director to chair that committee.

With MACIPA’s own IT staff growing, there also was a need for better interdepartmental communication and collaboration, she added. Regular “E-Quality” meetings include staff involved in account management, quality improvement, data and reporting, the IT Committee chair, and the medical director.

The IPA also has formalized client agreements with physician practices to detail service level and user agreements as well as security policies, fee schedules and business associate agreements. Issues include early termination fees and who owns the software license and the data.

Now MACIPA is turning its educational efforts to meaningful use. It recently hosted a meeting attended by 100 physicians featuring John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center and Harvard Medical School. “That talk really raised the bar for our practices and helped them understand this is part of a national effort,” Lyons de Neufville said.

MACIPA is planning to do gap assessments practice-by-practice and develop a training plan that will bring physicians to the first and later stages of meaningful use. “We have to help them understand what work remains for them to accomplish meaningful use,” she said. All of these steps describe the creation of an increasingly sophisticated organization that involves physicians in the decision-making processes, but seeks to ease the burdens of training and support on small practices. It also plays the increasingly important role of interface between all those independent physician practices and area hospitals and laboratories.