Managing Your Practice: Answers to your questions about...

Assisting in surgery

Q. What are the financial advantages and disadvantages of having members of our practice assist each other in surgery? Is it more profitable to assist, or to keep seeing patients?

A. First look at the schedule of the colleague who would be assisting. Does he or she have free time? If so, using it to generate revenue as an assistant surgeon is better than sitting idle in the office.

With that information, you can determine when and if it will pay to assist on a given case or type of case, rather than staying in the office. You may find that it's never advantageous to assist during what otherwise would be office hours. If so, consider scheduling surgical assistance only at times when you would not be seeing patients anyway, such as lunch. Or, if a member of your group is assigned to remain in the hospital during the day on obstetrical duty, you might find it profitable to have that physician assist, since he or she is already on site.

If the numbers and your practice situation really don't favor serving as assistants, consider working out an arrangement with other practices in your area to have their members assist you. Maybe their physicians would welcome the income.

Buying an EMR

Q. Should we invest in an electronic medical record?

A. In the classic 1960s film, The Graduate, "plastics" represented the future. Today in ob/gyn, it's "electronics." Without question, all ob/gyn practices eventually will need an electronic medical record (EMR). Computerization is essential for accurate and prompt information exchange within a practice and between other entities involved in patient care. That having been said, the best time to implement an EMR and the choice of a vendor vary from practice to practice.

Small groups should seriously consider an application services provider (ASP). With an ASP, your practice leases software and a server and your data are kept off-site. The key advantage is the minimal investment in the equipment and maintenance. For a small practice, it makes sense to look outside for expertise in information technology, rather than buying equipment and burdening staff with managing an EMR in-house. An important new option for mitigating the cost of going electronic has been made possible by a recent modification of Safe Harbor regulations: hospitals are now allowed, with certain restrictions, to finance much or most of the cost of EMR software for private practices, so do check with your local hospital(s) to see if this is feasible for you.

Managing your own data and investing in software, servers, and staff to optimize control and customization may be a good choice if you have a large group practice. The key here is doing your homework before making an investment. Have one or more members of your group who are computer-savvy and know how to manage overhead evaluate products and vendors at a large, national meeting, such as ACOG, American Medical Group Association (AMGA), or Medical Group Management Association (MGMA). Gather information about the range of products available and their costs, and survey your physicians and staff and consider how they operate so that you can match the EMR to your practice's needs.

If you have existing practice- and laboratory-management software, you'll need to determine how the EMR will interface with it and you may need to purchase a comprehensive IT package. Make sure that any vendor you're considering is well-established and financially stable, and check multiple references. Also make sure that the vendor is ready and willing to provide comprehensive and convenient technical support, which you will definitely need regardless of how carefully you select the product. Discuss the need for and timing of future software and equipment updates with the vendor .

Once you have narrowed down the list of EMRs to a few "finalists," find out how well the products work in the real world by visiting ob/gyn groups similar to yours that already use the technology. Demonstrate the products to members of your group and your staff to test their usability. The more intuitively a system fits into your practice's work patterns, the better. Compute the cost of implementing your chosen EMR, including the software, hardware (don't forget terminals in every office and pod), and support, and make sure that there is space in your budget for it, both as a capital investment and as an ongoing expense.

If you follow all of the steps outlined here, it will take you several months, at least, to fully consider and put into action an EMR. The sooner you start the process, the better it will be for your practice.