Eric and Ann Fishman, with EHR TV, speaking with Scott Decker, President of NextGen.
Dr. Eric Fishman: This is Dr. Eric Fishman with EHRTV and along with Anne Fishman, we are discussing NextGen Healthcare with Scott Decker, President of NextGen Healthcare. Scott, thank you for spending some time with us again.
Scott Decker: Sure.
Dr. Eric Fishman: A phenomenal amount of activity is occurring in the health information industry and bring us up to speed about what has happened with NextGen over the last few months.
Scott Decker: Well, our clients are going just like the rest of the industry right now. So, first thing on everybody’s plate for the last year really or 18 months now has been getting to meaningful use and we are happy to say that our clients I think are probably right at the forefront of that of now not only being implemented and having everything working together but starting to see dollars coming through the door. So, that’s pretty exciting for our clients and pretty exciting for our company because that’s really been top of agenda. At the same time, while we’re in a somewhat tactical mode of how to get meaningful use dollars, really the impact of just the changes with how healthcare is going to be delivered over the next couple of years, doing a lot of exciting stuff with our clients on positioning for the future.
Dr. Eric Fishman: If I recall correctly, you were one of the first or may be the first to provide essentially an ironclad guarantee of meaningful use dollars. Anybody making any claims on that?
Scott Decker: No. Like I said, I mean, we got everything there well ahead of schedule and clients are coming up. So, I feel pretty safe on that bet right now.
Ann Fishman: Are you able to prepare your end-user group for ICD-10?
Scott Decker: Yeah. So, if meaningful use was a challenge to get everybody ready for… no time to take a breath right now because we are going right back into getting ready for ICD-10. So, our commitment to our clients is to hopefully get them software that will enable them to start to get ready a year in advance which means by next fall we will be delivering that software to the clients. That gives them a year to get ready but to be honest, I think part of it is on our side but just as importantly is the payer community being ready for that and I hear a lot of question marks on whether that’s going to happen. So, a lot of work for everybody over the next 24 months.
Ann Fishman: Because the onus seems to be on the physicians and the hospitals and not on the payers. Is that correct?
Scott Decker: I mean, certainly the providers have to be ready to submit the data and all the systems need to be in place but at the same time the payers need to be able to take that data, right, and do something meaningful with it. So, I don’t know if you can really say all the onus is necessarily on one and I think what we are going to end up with is a hybrid type environment where some payers are ready to go and some aren’t and that’s just going to add another layer of confusion to this whole thing.
Dr. Eric Fishman: A number of years ago, NextGen was centered in the middle of large physician offices and since then it seems as if you have expanded to both sides into enterprise opportunities as well as very small practices. Where is your focus at this point in time?
Scott Decker: The interesting thing is if you are going to be an enterprise player, it really means you are going to go the whole gamut because our largest clients, let’s take Adventist Healthcare or an HMA for instance, not only do they have all the physicians in their network but they are buying up practices as quick as they can and really the practices they are buying up are the small practices. So, while you can say in some respects we are supporting enterprise clients, a lot of enterprise clients are really made up of a bunch of small practices. So, our focus is on enterprise clients but to do that, we really have to go and support across the whole gamut, absolutely down to the small practice.
Dr. Eric Fishman: In the cloud…
Scott Decker: In the cloud, right, and it’s interesting. I mean, that’s picking up so much momentum just, I would say, the vast majority of our deals now are cloud based or outsourced.
Ann Fishman: Is that where everyones going to migrate ultimately, do you think?
Scott Decker: I think so. I mean, it’s always seemed intuitively that that would make sense and I think the industry has taken longer than a lot of us would have guessed. So, I don’t see anything slowing that down.
Ann Fishman: Are there more challenges for you in terms of security in the cloud?
Scott Decker: I don’t think so. I mean, it’s different challenges but I feel a lot more comfortable that our security can be locked down in a big environment with really enterprise practices that we run as opposed to worrying about is the doctor really taking care of the data in the small practice and have all the discipline which ultimately we would be held accountable for. So, it’s different but I prefer that model actually.
Dr. Eric Fishman: You said the magic word ‘accountable’ and if you don’t mind, we’re going to play a little acronym game – I will say an acronym…
Scott Decker: Okay.
Dr. Eric Fishman: …and then the first thing that comes to mind. I will start with ACOs.
Scott Decker: Yeah. So, ACOs is dynamic I would say. So, it was the hottest trend that everybody wanted to talk about a year ago and its almost whipsawed now to a lot of organizations we walk in to say “well don’t even bring up that word to us” because I think they have realized the complexity of it and how maybe they aren’t quite prepared for it and how it may be changing fairly quickly.
Dr. Eric Fishman: Tell me what changes you think will be happening in the next year or 18 months from what we have heard of ACOs
Scott Decker: Yeah. So, if you step back from it, I think almost across the board everybody feels like we are moving towards a model that’s much more quality focused and outcomes focused and, in essence, that’s what accountable care organizations were all about. I think nobody knows what the final model will be but everybody is trying to position themselves to be more about how do I manage my population of patients rather than just that episode of care and that’s a pretty dramatic change.
Ann Fishman: How about RCM?
Scott Decker: RCM is also gaining momentum and I think we are just talking about ICD-10 and I think you will see actually an acceleration of RCM because RCM is a way for clients to quickly get on to a new environment for their financial systems and I think there is going to be people behind the curve on ICD-10. So, it’s been pretty popular already and I think we will see even more momentum behind it.
Dr. Eric Fishman: And then if we go to another R acronym – RECS. There has been some mixed reviews about the RECS.
Scott Decker: Yeah and I would say real candidly I would give it a mixed review too. I think there is a few handful across the country that are having meaningful impact on the markets and I would say the vast majority, it’s a little tough to say are dollars being spent the best way they should.
Ann Fishman: Do you think adoption will be on target, on schedule?
Scott Decker: No, I don’t. I mean, I think you can already see that the dollars that the government is reporting of people getting their meaningful use dollars are behind what they had projected.
Dr. Eric Fishman: I hadn’t noticed that. How much behind are they?
Scott Decker: It’s hard to say because they are being a little bit cagy with how they present the numbers but it’s pretty clear to us that it’s not at the pace they had expected and I don’t think that surprises anybody. I mean, this is tough stuff for practices to implement. At the same time, I do think we are seeing momentum build and I think we are getting more and more of a critical mass. So, I don’t think it’s going to die but it is going to be slower than what people had anticipated.
Ann Fishman: And the end result will be better health patient care?
Scott Decker: Yeah, I think so. I mean, everybody believes, I think, hopefully that getting electronic health records in place raises quality of care and if nothing else, if it’s just speeding up and serving as a catalyst to get us there sooner, it will and the interesting thing is stage 1 is let’s get to meaningful use in an EHR and a doctor practice and I think that has a little bit of value. It’s really the next stage when we start connecting up together. That’s where the real…
Dr. Eric Fishman: It seems to be self evident you’re really working on that…
Scott Decker: Yeah, absolutely.
Dr. Eric Fishman: So, a final acronym – CDS.
Scott Decker: Yeah. So, if you think about where healthcare is going and if ACO or taking care of really population of health, it becomes more and more meaningful; rather than just charting a visit, we are now really moving towards managing a population, right, and to really do an effective job of managing a population of patients, you’re going to need that clinical data repository or some fairly sophisticated infrastructure that you can then run rules against to manage your population and mass. So, we are doing a lot to invest in that area and I think you will see the whole market shift that way but it’s going to be another kind of division of who is really just building transactional systems and who is really building more sophisticated clinical systems because this gets pretty sophisticated when you start trying to manage massive amounts of data and populations.
Dr. Eric Fishman: So, we have spoken a little bit about the future but what do you see as the biggest thing that will be happening in NextGen’s future in let’s say next 12 months.
Scott Decker: Yeah, in the next 12 months, unfortunately it is a lot of blocking and tackling and maybe that’s not unfortunate but… I mean, it is really just getting our clients to meaningful use and it’s starting to get them prepared for ICD-10. That’s the next 12 months. I don’t think there is a lot else going on. Now, with that said, we have some fairly large sophisticated clients, for instance a Caremore or a Monarch, who are around on the west coast who have now banded together with insurance companies to really say what’s the next model of healthcare. So, while there is a lot of blocking and tackling, there is some pretty exciting things we are doing that I think gets us to that population management and CDS kind of environment.
Ann Fishman: When you are running a company, are you an IT guy or a business guy?
Scott Decker: Probably more a business guy though you have to have a pretty good dose of IT to make sure you know what business you are running.
Ann Fishman: Which of the many stakeholders are uppermost in your mind as you are having to move your company forward?
Scott Decker: Yeah, that’s a great question because it’s easy to get distracted and lose focus on who really your client is and foremost I think is the physicians for us. I mean, if we do right by the physicians and really help them deliver better care, be more financially successful, take better care of patients, we are going to win and my only hedge I am going to put on that is we got to start putting a little eye toward the patient. So, it’s probably those two constituents, more heavily weighted right now for us towards the physician.
Ann Fishman: Do you think that the personal health record model has any real significance in protecting, you know, the patient as a stakeholder?
Scott Decker: I think it will over time and I would put personal health records kind of in the same boat. We talked about the cloud a little bit ago. It makes a ton of sense but it’s way behind where any of us would of intellectually thought it should be. I mean, at the best, I have a handful of clients who are even thinking about PHR and that’s always my best gauge of, you know, how real is this. I have a broad enough view of the market to say how many clients are working on it, not that many are focused on it right now.
Dr. Eric Fishman: We have spoken about the relatively slow uptake, industry wide, on patient kiosks and the ability for the patients to pay.
Scott Decker: Right.
Dr. Eric Fishman: That hasn’t expanded very rapidly still, has it?
Scott Decker: Yeah. And so that would be one I would say is on the launch curve right now. So, a year ago I probably wouldn’t have even said it’s in the foreseeable future. I think you will start to see at least sophisticated pilots in the next 12-18 months on that front.
Dr. Eric Fishman: So, thank you very much.
Scott Decker: Yeah, thanks again.
Dr. Eric Fishman: Always a pleasure.
Scott Decker: Always great to see you.
Dr. Eric Fishman: Thank you.
This is Eric Fishman with EHRTV and we have been speaking with Scott Decker, President of NextGen Healthcare.