Meeting MU On A Tight Budget

[In an interview with earlier this year, Tom Ciccarelli, CIO at East Orange General Hospital, said that if he had to do his EHR install again, he would have brought in consulting help. The problem is that the 211-bed community hospital lacked the funding required to bring on consultants. Below, Vince Ciotti offers advice for organizations that find themselves in the same position.]

Vince Ciotti, Principal, HIS Professionals

Meeting Meaningful Use (MU) on a tight budget? It’s a challenge, but here are some suggestions:

1. Negotiate Vendor Rates. If you haven’t signed with you’re HIS vendor yet, be sure to negotiate the hourly rate they’re charging for their implementers. Most vendors charge a flat fee for implementation, but give you no idea how many days you’ll have their people on site, and what they will do, versus your stressed staff. Be sure to ask for a detailed work plan that lists every hour/day they’ll be on site, what tasks they’ll perform, and what the hourly rate they’re charging you for each person: analyst, RN, MD, etc. When you get their hourly rates, multiply it by 2,000 and you’ll have a rough idea of what the equivalent annual salary is. So, if they are charging $175 an hour for an RN and $250 an hour for an MD, that’s the equivalent of $350K a year for the RN and $500K an hour for the MD. Sound high? Darn right, so start negotiating! Vendors only pay them the going market rate, which is about $100K for a very experienced RN, who has been with them for several years, and knows the product you are buying. If they are inexperienced, the vendor should pay you to train them, not vice-versa!

2. Make Consultants Compete for You. If you do have to hire a “consulting” firm for implementation assistance, apply the same rules. The quote marks, by the way, are because a “consultant” used to be someone who was an expert in a specialized field, and came to your hospital to study a problem you were facing, give you some valuable advice, and then leave. Today, “consulting” firms are hard to tell from vendors: they both make hundreds of millions (or billions!) a year in annual revenue, have thousands of employees, and will do anything including windows (the older the release the better — the more hours they’ll be able to bill!). Both want to “partner” with you, which means partner with your checkbook, hang around forever if possible, and drain you financially while you train their often-inexperienced new hires. So what to do? Make “consulting” firms compete the way vendors do: get a detailed work plan in writing that documents what they’ll do versus your staff, how many hours they’ll be on site, what the hourly rate is for each position, etc. Check out the equivalent annual salaries just like with the vendors, and negotiate. Tell them the other guy only wants $150 for an RN, why do they charge $175? For “demos,” insist they bring their actual team on site (not just corporate sales execs), give them a tour of your floors, and have the actual project leader you’re buying present what they found as a result. It gives you some free consulting (for example: “OB needs far more devices!?”) and let’s you see if their project manager can walk and chew gum at the same time.

3. Do Your Homework. Lastly, check individual consultants’ references carefully, as with a vendor. You did demand resumes, didn’t you? They’ll contain a handful of “happy clients;” call them and ask each for some other references, and you may finally ferret out some of their inevitable unhappy clients. Listen to them the most. Every consultant (and vendor) has as many weaknesses as strengths: your challenge is to find them before you buy. Think in terms of “buying the least of the evils” and you’ve got the right mindset. No, it’s not being mean and negative — it’s being a realist and saving your hospital’s precious funds for really important things like more permanent staff and new medical equipment, not temporaries who will take with them the expertise they learn at your site!

So if you’ve got $300K or $400K to spend like that CIO in NJ, spend it wisely! Negotiate a low rate, get some experienced bodies on site to do some real work (not just “advise” and “guide,” but actually do something), and you may get the outside help you need to achieve MU on a tight budget.


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