It was going to take a lot to draw Tim Moore back into the workforce. That’s because Moore had been there, done that. He’d found success in all his career endeavors, made some money and bought some houses (a few in sunny Mexico). But one day Moore got an offer even he couldn’t refuse. That offer came from Hoag Memorial Hospital Presbyterian, and Moore couldn’t refuse it because, in it, he saw a unique opportunity to improve the healthcare of an entire community, an opportunity that “very, very, very few other places” could offer. To learn more about Moore’s work, along with the laws he’s developed along the way, healthsystemCIO.com editor Anthony Guerra caught up with the California-based CIO.
About Hoag Memorial — “There’s no place like Hoag”
Attaining physician stickiness in California
Move away from Stark, towards HIE
The application environment: Allscripts (Eclipsys) for clinicals, QuadraMed for RCM, along with “two of everything else that has ever been sold”
Thoughts on the merger — “Eclipsys was getting a little long in the tooth and a little too sure of themselves”
Evolution of a hospital-to-physician HIE strategy (using Medicity)
The art of negotiation
Guerra: Tim, thanks for being with me this afternoon to talk a little bit about your work at Hoag Memorial.
Moore: I’m delighted to be here. Thank you for asking.
Guerra: You’re very welcome. I see that you have 2 hospitals, 7 health centers, a network of more than 1300 physicians a whole a lot of other stuff. Do you want to give the listeners some more color on your organization and we can go from there?
Moore: You have that correct; we have 2 hospitals that are 100% owned by Hoag. We also opened up in November a joint partnership hospital which is the Hoag Orthopedic Institute, which is majority owned by Hoag, but we are in a kind of a unique partnership with a number of world class orthopedic physicians that have come together to perform the other half of the venture, if you will. In addition to that, I think what people should know about Hoag is, it is a very special place. I’ve been in the business for a long time. I’ve had the pleasure of working at a lot of very wonderful, talented organizations and wonderful communities, but I can tell you, and I tell many frequently, that there is no place like Hoag. It is a very special place.
Guerra: Is that your jingle?
Moore: It’s informally a bit of a jingle, yes. I don’t think it’s any formal jingle, but it is used frequently and I think it is very apt.
Guerra: “There’s no place like Hoag,” I love it.
Moore: Some of the things that make it so, is it has a perfect mix. First of all, let’s be honest that our main corporate campus in Newport Beach sitting on the bluff overlooking the water is about as beautiful a setting as one could hope to go to work at any day.
You mix with that that you have a community that is just unwavering in their support in its entire history, just backing Hoag. And by backing it, I mean just intellectually backing, implicitly trusting what Hoag is doing. They have contributed; we have a very large core of volunteers here. I’ve never seen quite as many volunteers; I think we’re up to somewhere in the neighborhood of about 1200 volunteers and then, quite frankly, our main campus sits in one of the most affluent areas of the country and those people open their checkbooks frequently for things that they think would value the greater communities that are served by Hoag and then you follow that down.
So you have the community behind us, and we have an expert board that truly contains some of the sharpest minds in the entire industry of healthcare. Many years ago – about 5, I believe, before my time at Hoag – there was a decision to go out and migrate to an expert board. We certainly have some very talented leadership in the board area. I work for the CEO, Dr. Richard Afable or Rick Afable, a medical doctor and he’s a visionary, and he understands healthcare at so many levels. He certainly understands the strategic value of information technology. So we interact at a level that is not so much a CIO explaining technology to a CIO but more about strategy, such as how do we stage this and how do we sequence this to provide the greatest value to the communities that we serve.
And then lastly, we have fabulous resources here and then we have a balance sheet that lets us do a lot of pretty neat things.
Guerra: So you’re not looking for a job right now, I take it?
Moore: I can honestly tell you when I leave Hoag – and if there was a reason that they needed me to leave tomorrow, I would leave with a smile and I would thank them for the time we had together – but when I leave Hoag, I would go back to doing what I was doing before I came to Hoag. I will be back in retirement and I will be back in Mexico.
Guerra: If it’s not Hoag you’re leaving the country.
Moore: That’s it. There you go. There’s a jingle – No Hoag, I’m leaving the country. :)
Guerra: That’s great and we’ll be getting to more of that little later. We will go for more of the traditional stuff right now. About how many beds in the hospitals if you combine them?
Moore: You combine them, we’re around 650 beds.
Guerra: Tell me about the physician mix in terms of employed docs or community docs that are not employed but admit to the hospitals?
Moore: In California, and this is not unique to Hoag Memorial – remember, we can’t directly employ physicians nor do we have a foundation which is a model used in California to, I’m going to say, in essence, employ physicians; I may have just offended somebody by saying that, but that’s the essence of it. But we have roughly on staff a little greater than 1,350 physicians and those are the whole spectrum. We have some of the finest oncologists. We have some of the finest cardiologists, neurophysicists – you name it we have them here at Hoag. We’re a community hospital by name, but in practicality, we are a whole different level than just a community hospital.
Guerra: So you have not employed any of the – we’ll call them – workarounds that we see in California to get some stickiness with the local physicians.
Moore: I would say in the traditional sense, no. In the traditional sense of being the foundation model type sense of it and there are a few other ways. No, but through the visionary leadership that we have in our CEO, I would say we absolutely have employed a number of things. And as I was sharing as we started out today, that partnership with HOI (Hoag Orthopedic Institute), that’s a real front and center example of that stickiness. The physicians now are almost half owners of that institution. They are the managing half, by the way; so we allow them to manage it. And they’re already great people to start with, but then you put them in the game with their own skin, it’s amazing – first of all, the stickiness that you refer to, but also their interest and their passionate drive to be efficient and provide the highest quality, because it’s now them.
Guerra: I know we’re going talk extensively about your HIE work, but regarding Stark, are you doing anything directly using Stark to underwrite the ambulatory EMRs for the independents?
Moore: Today, no. Today, no. We may in the future revisit that. We were one of the first in the country. We may actually be literally the first, but we are certainly one of the very first in the country that did offer a subsidy program. We have put in place – and I do not take any credit for this, this was the brilliance of some of my predecessors – they put in place, did all the legal work, and they had all the contracts already hoping there was going to be a relaxation in the Stark, as you well know, there came to be. Literally the day it was, they started launching the subsidy program to those that had interest. So we got up to right around 150 give or take physicians that we provided subsidy to and still provide subsidy to. And then we redirected those funds. We were ahead of anything that was out there incentivizing, I guess, carrot before the stick on adoption of the EMRs. Ultimately we recognized that those are great, that’s wonderful that we have those standalone EMRs, but the real future is, in our opinion, is the interconnectivity in the Health Information Exchange. We redirected our funds and added substantially more dollars to provide a community interconnect.
Guerra: Let’s start with the inpatient environment. Tell me your core clinical vendor and maybe some of the other vendors that play in your inpatient space, and we’ll go from there.
Moore: Our core on the inpatient side is Allscripts. Of course, Allscripts was acquired not too long ago by Eclipsys. So they with us through their Sunrise Care Manager Product Suite. They have the lion’s share of our inpatient and then, maybe like a lot of hospitals that have been around for a little while, I tongue in cheek say we have two of everything else that was ever sold. So we have a large variety of other product suites.
On the rev cycle, we use QuadraMed Affinity. Surgery, we use SIS. But in all honesty, I mean, it just goes on, and on, and on. We have as many different applications as you’re going to see in an organization – we’re almost pushing 500.
Guerra: Just briefly, Eclipsys, what have you seen since the merger, any effect on your end as the customer, good or bad?
Moore: So far (knock on wood, and I have real wood desk here in front me and I’m knocking on it), it has given signs of a positive thing. To be frank, I think Eclipsys itself was getting a little long in the tooth and a little too sure of themselves, as far as who they were and how they fit into the big picture, and I think Allscripts with the nimbleness they’ve had to have in their primary business market up until now, I think they’re going to show Eclipsys some new tricks.
Guerra: Interesting. Now without any sort of big ambulatory owned facilities, you don’t have any real skin in the game of terms of which… you don’t need something to line up well with an outpatient solution; it’s not like you’ve got practices that are owned, that are all on Allscripts, or that are all on Cerner or something. You’ve got this mix of 1,350 physicians out there. So really, it’s not that important that you line up directly inpatient and outpatient, does that make sense?
Moore: It makes sense. It is critical that we get them connected. It’s absolutely to us, it is critical. I mean we exist and I mean you poke us and we’ll bleed the little DNA that you could trace and verify as an organization. We exist to serve our communities. We make no bones about it. We’re only here because the communities need us to be here and they want us to be here. So our communities want us to be better interconnected. And there’s lots of different players on how to do that and a lot of different institutions are doing it different ways very successfully. Ours to date has been, let’s bond with the physicians in their environment. Let’s make those connections. But as you’re saying, do we need to be Epic, do we need to be Cerner out there and say here’s one flavor, use it or you’re not one of us. No, that is certainly not our strategy.
Guerra: You don’t even the same incentive that some of the people going with Epic do. I mean some of the people going with Epic, they have a few hospitals and a whole bunch of practices either owned or not owned, but… anyway, they want everything to be on one system. In your environment, inpatient and outpatient, that doesn’t make any sense. You’ll never get the kind of synergy. I see you’ve gone with more of an HIE-type cloud strategy, right?
Moore: That’s it. That is absolutely correct.
Guerra: Tell me about that HIE road you’ve taken, sort of take me back as far as you can in terms of crafting the strategy and then some of the specifics of putting it together and where you are now?
Moore: It’s an interesting road, and I’ll go back a couple of years ago.
A couple of years ago, the organization started reading tea leaves and recognizing there is something about this data exchange and we’re doing it now and point to point in all kinds of interesting ways, but realized that’s not really sustainable if the vision is to be delivered. So we brought in Deloitte Consulting who we’ve worked with extensively over the years and they help facilitate a very formal assessment of the environment, and so in that assessment of health information exchange, they looked at those that are doing it, those that thought they’re doing it. About 35 such vendors were initially reviewed and then from that they narrowed it down to around 15 vendors that had some substance to the point where we believe that they were providing some form of an HIE. Ultimately, that was brought down to a group for detailed analysis of 4 and that was Axolotl, Allscripts, Orion, and Medicity. The final list on that were finally culled down and we had some very detailed discussions with Medicity and Allscripts and ultimately we went with Medicity. In that path, then we went down and negotiated with Medicity.
Let me back that up just a little; initially, we negotiated with Eclipsys. Eclipsys had a partnership at that time with Medicity and they asked us if we would do the deal through them. We were most obliging to do that. We saw some benefits to work with a single vendor over two vendors, but that didn’t work out. It was very clear that Eclipsys, at least at that time, although they desired the business, they had no idea what business they were desiring.
Guerra: Give some more color on that.
Moore: It’s just we would have discussions that were very much so in depth as far as what we expected of it and how an HIE should work and what kind of contractual words need to be there to assure mutual success. So I have a philosophy in it. I know many people share this philosophy, but I truly execute to it and that is if a solutions provider is willing to tell us they will do something, if they’re sincere about it, they’re also willing to put that in writing. I would just say it was a near impossible process to finish that contract and I think we both just realized, “You know what, this isn’t in our best interests.” It was probably better for Hoag to go direct with Medicity to create a contract… I’m not exaggerating this, a contract that we have been working many months on, we finished up in two weeks and got a contract that I think Medicity would tell you absolutely serves what they need to be successful, and I can tell you without a question that it serves what we need at Hoag to be successful, and some very unique pieces that we put in there as well to recognize that we were doing something just a little bit different.
Guerra: So those were the same pieces that you had tryied to get Eclipsys to put in and they were reluctant?
Moore: They were extraordinarily reluctant because they just didn’t understand the space. I don’t mean that in a negative way, I just mean that as a statement of fact and I think they, if they were being honest with themselves, would tell you the same thing. They saw an opportunity for a deal to be done and they didn’t understand what they’re getting into, quite frankly. Even though they had done some other deals, this was something with a lot more depth to it. Like I said, we have spent a significant amount of research, we knew what we needed.
Guerra: Was their involvement diminished by the fact that they were not the ones negotiating? I’m wondering what their interest was in actually being the one negotiating or was it all going to be the same either which way?
Moore: This is where it’s interesting. I am not telling you anything that isn’t public as such; actually our negotiations started with the three of us – Medicity, then Eclipsys, and Hoag and then it converted to just Hoag and Eclipsys without Medicity. It became apparent after several weeks that the conversation was going absolutely nowhere. They just didn’t understand the space. That’s all I can keep saying. They just did not understand what they’re wanting to do and they were not coming prepared as they would need to, not prepared enough to deal with somebody like myself who has been in this business for long time and been on both sides of the fence many times. Platitudes and vagary just weren’t going to work. So we ended up going another way and getting in with Medicity. We brought in their senior executives and shared our vision with them very clearly, put the stakes on the perimeters of how far we’ll go on different things. Told them what we’re trying to accomplish in a partnership and not just the sales version of a partnership, but a true partnership, what we would require. They mulled it over, it made them a little uncomfortable and that’s always good to make them a little uncomfortable because the amount of money we’re investing makes us a little uncomfortable. So we have a level of discomfort, if you will. Then we went forward and we’ll talk some more details, I am sure. But cutting to the end, right now we are delighted with our choice. We are truly delighted with Medicity. They are executing to their commitments.
Guerra: At any point when things got sticky with the Eclipsys talks, did you think of going back to the other 3 of the 4 finalists going back to them or did you say hey, we’re done here; we’re going to go back to our short list and pick someone else.
Moore: You know, we absolutely did and it came down… Let me be very, very blunt; now this was before it was public knowledge between Allscripts and Eclipsys becoming one, right. But Allscripts was a very, very, very close second and we definitely at that point thought about going back to them and it was my call to Brent Dover at Medicity and his response… he’s going to hear it on this podcast I guess. He probably doesn’t even know that, but it was his response that was so gentile and open to, “Hey let’s make this work.” That said, “Okay, let’s give that a try.” But if I had to spent one more day hitting my head against a wall, we would went someplace else.
Guerra: Good thing that didn’t go into his spam folder.
Moore: That’s right.
Guerra: On such thing as the world turns, right?
Moore: That’s right. That’s true.