As hospitals of all shapes, sizes and complexity sprint for HITECH dollars, many are looking at consultants to fill gaps in their healthcare IT intellectual capital repositories. Offering everything from system selection expertise to contract negotiation to temporary staffing augmentation, many organizations won’t best Meaningful Use without outside help. To gain insight into just what type of work is being requested, healthsystemCIO.com editor Anthony Guerra recently chatted with Beacon Partners CEO Ralph Fargnoli.
BOLD STATEMENTS
Often it gets into the dynamic of physicians versus hospitals, if you will, especially if they’re not employed physicians.
The negotiation process used to be pretty standard, but now it has a couple of twists and turns because it’s being tied to stimulus money …
I think many people are concerned right off the bat that they don’t have the time, money, or resources to even do Stage 1 …
GUERRA: How can an organization determine if they have the in-house capabilities to handle an IT project or if they need to bring in outside consultants?
FARGNOLI: I think where organizations can effectively use consultants is in the strategic planning or the planning, if you will, of how do I get every dime that I’m able to through the years 2011- 2013. They leverage consultants’ experiences and lessons learned from other organizations. For example, if you’re working with a specific vendor, how do you have to change your priorities, and if you change the priorities of your IT adoption within your strategic plan, what are the things you need to do. Then, what are the types of resources that you need. And I think that’s where the value of the consultant is — helping them modify IT strategic plans to get every dollar they can.
The other thing that I think consultants can do is help with clinical transformation and EMR adoption. Often it gets into the dynamic of physicians versus hospitals, if you will, especially if they’re not employed physicians. There’s a lot of facilitation that has to go on in terms of governance, controls, data access, and I think that’s another place where these organizations can utilize outside people to help them with the discussion and the debate, and we’re seeing more and more of that — where hospitals do want to align with physicians, but it’s the age-old story of trust, access, and ownership. Outside consultants with the right experience can help move these discussions along so that both sides — physicians and hospitals — can come to a point where they agree, and then move forward with the adoption when everyone benefits. The physicians benefit from having their records within the hospitals, the hospitals benefit from more admissions and so forth.
Those are the areas that I think that healthcare organizations can look to consultants. Lessons learned, experiences, sharing all of that with new clients, if you will, to move things along. I think a lot of consultant firms have staff augmentation; to me, that’s great. If you need a body, we can provide a body, but I think there’s more value in the assessment and planning side.
GUERRA: Do you assist with vendor selection and contract negotiation?
FARGNOLI: Yes, we do. We’re pretty much a neutral company when it comes to vendors, and we do help in the areas of RFP development, search and selection, and then finally, the contract negotiation. And one of those areas now that we’re looking for, what we’re seeing in the contract negotiation is meeting the certification requirement — does the vendor have the certification issue covered and what is the sustainability of that certification. The other thing that we see is where vendors are offering the financing of systems and you don’t have to pay that back until you start receiving your money from the Medicare or Medicaid program. The negotiation process used to be pretty standard, but now it has a couple of twists and turns because it’s being tied to stimulus money, and the vendors have to meet some level of expectation for the industry’s certifications.
GUERRA: It would seem to me that as a provider you could definitely use a consultant to help make sure you’re getting the right deal, but you also need a good lawyer. Does that make sense?
FARGNOLI: Yes, very much. What we see is that organizations will use the consultants for the vendor-specific areas of implementation, upgrade, support, basically service-level agreement language, and then what we see is either internal or external attorneys with the experience around limitations of liability, warranty, certain state-specific items that need to be addressed by a legal person. There are two sides of the contract negotiation. As I call them, one is that legal person that understands the local laws, especially state government laws, and then there’s the other side where we work, which is the vendor-specific issues, and we highlight those and bring those to bear during the contract process.
GUERRA: How often are you brought in when things have gone bad, when an implementation is just totally bogged down and in a complete mess? Has that happened quite a bit?
FARGNOLI: Over the last three years I probably can cite probably four or five times where we’ve been brought in after the fact, where some organizations have thought they could hire some contractors, manage the contractors and then do it themselves for a good price, but they learned the old adage of, “pay me now or pay me later.” In both those instances where we had first negotiated a contract price or proposal and people have come back to us, it usually is almost 1.5 to 2 times as much to fix the problem as it would have been to do it right.
Where we see these organizations go wrong — and we see it already happening — is they’re hiring contractors, basically single people out there that have nothing in common, they’re trying to bring them in to an organization and create a team. That team is being run by an individual within the organization who might not have much project management experience, but the real challenge is you’re working with non-related people who don’t have a common value, a common service excellence, and that’s where we see these thing go wrong.
Beacon will get a call and hear, “Look, we need a team of people here under a project manager,” and by the time we go in, we have to take a few steps back to fix what was broken before we can move it forward. That’s why I say you can pay me now or pay me later, and we’ll negotiate our best price with you. But I think when you use any consulting firm, it puts a team of people on your side, and they have a common goal — to help the client. They’re all trained with a consulting perspective of what’s best for the client. The rework is always more expensive.
GUERRA: We constantly hear about the HIT workforce shortage. When we spoke at the CHIME Fall Forum, you mentioned you were looking to hire. Have you been able to find the right people?
FARGNOLI: As I had mentioned to you, we’ve been hiring since December, and I think we brought in probably about 25-30 new people, and we have a need for many more. What we’re seeing out there right now is a diverse population of people that maybe have a single skill set, if you will, and we’re trying to find multifaceted people, but they come at a premium and there not too many of them. We’re in a hiring mode, but we’re still being cautious. As I told the company in my January address, we see the first quarter as a slow growth period. We do have needs for skilled people, but we’re going to take our time in our hiring process. The challenge to find the right people is out there.
GUERRA: Better to take it slow when hiring, right?
FARGNOLI: Very much. It costs a lot of money to hire people, and we want to make sure we have the right fit for what our needs are.
GUERRA: Your people work pretty independently. They’re out there a lot of times at the client site alone, so you can’t have someone who’s not representing your company properly.
FARGNOLI: Exactly right. We have a good structure in place. Our management team is always in contact or onsite with the consultants and the clients. We spend the time and resources to make sure that our people are always connected to the company.
GUERRA: If you could say anything to David Blumenthal, what would it be?
FARGNOLI: He needs to make some of the Stage 1 items achievable within a short timeframe and build up to the remaining stages as we move along. I think many people are concerned right off the bat that they don’t have the time, money, or resources to even do Stage 1, so I look at it and I say why don’t we make it so that we have some quick wins and give them some goals that they can achieve in a short amount of time. That way, everyone within these organizations can see that they’re moving forward. I think there’s so much, and it’s very ambiguous right now. The first thing we’re hearing is, “We’ll never do this, we’ll never get to Stage 1, we’ll never get the first part of meaningful use because it’s not clear, I don’t have the resources.” I think Blumenthal should take a step back and make the items achievable so everyone feels they are moving forward, that they are having some successes. That would be my advice.
Share Your Thoughts
You must be logged in to post a comment.