California IPAs Take Increased Role in IT Adoption

A recent survey of physicians found wide gaps between small and large physician practices’ IT adoption. But in California, several forces are attempting to change that, with large independent practice associations in the state beginning to play a larger role in shaping physicians’ IT uptake.

San Francisco-based independent practice association Brown & Toland recently announced that its more than 1,500 physicians could gain free access to online lab results as part of a larger $10 million plan to get its 700 members using electronic medical records and practice management systems. Brown & Toland plans to buy the EMR software licenses and resell them to members. The IPA would provide support for the software, and physicians would pay up to $450 a month for a full EMR.

The IPA is no stranger to IT. It’s been making investments in such services for the past decade, according to Nancy Griest, vice president of medical group services for Brown & Toland. The IPA plans to include lab information from partner hospitals and next year will roll out EMRs to several offices. Griest said the IPA hopes to have 15 practices using an EMR by the end of 2005.

Elsewhere, one of the biggest IPAs in California, Hill Physicians Medical Group, plans to begin piloting an EMR system with its members in 2005. Hill recently announced that it would absorb Delta IPA, a 500-physician medical group in San Joaquin County, making its decision to test EMRs likely to influence many physicians in the state. The IPA currently gives its members electronic access to eligibility and claims data. Craig Lanway, CIO of Hill Physicians Medical Group, said the IPA decided to invest in IT because its members tend to be small practices with very little technology adoption.

In addition, the California Association of Physician Groups is leading an effort in the state to create a clinical data repository that would include hospital claims information, laboratory claims and insurer and pharmacy data to help identify patients whose care does not follow certain clinical guidelines. Ten California physician groups and IPAs will begin compiling the information in January. The California HealthCare Foundation is providing technical assistance for the project.

Although IPAs are starting to make inroads into spurring technology adoption, several barriers exist to making a wired doctor’s office a reality. Chief among those challenges are the financial barriers that exist for IPAs, Dr. Antonio Linares — vice president of medical affairs for Lumetra, California’s Quality Improvement Organization for Medicare — explains. Lumetra is leading Medicare’s Doctor’s Office Quality Information Technology (DOQ-IT) project, which aims to spur EMR adoption in small and medium-sized physicians’ offices in three states, including California.

“IPAs still face a financial barrier” to IT adoption, Linares said. “There has to be some business case mode for the IPA.”

Because Medi-Cal reimbursement rates in California are low, the physicians are not left with a lot of funding for IT investment, according to Linares. Richard Angeloni, director of communications for Brown & Toland agreed, saying that most IPAs “operate on razor-thin margins” and cannot make the same type of investments that Brown & Toland, a large IPA, did.

While financial barriers to IPA’s technology adoption are formidable, investment alone won’t guarantee that technology gets into physicians’ hands. A 2001 study from CHCF and the Healthcare Change Institute found that investment was only the first step. Practices need support at all stages to be successful, the study of 48 medical groups and clinics around California found. Linares also pointed out that it can be more difficult for small IPAs to implement technology, where a few doctors opposing an IT implementation could make a big difference.

In addition, technology itself can be a barrier. When Lori Hack, executive director of HealthTech, led the Alta Bates Medical Group IPA several years ago, she said that getting an IT vendor who could meet the needs of both large, multispecialty practices and solo practices was difficult. Vendor stability was another issue, with many health IT companies going out of business and leaving doctors stranded without support for the systems they had just purchased. Some of these technology issues still exist.

“You don’t have simple plug-and-play electronic medical records, so there is still a lot of confusion in terms of looking at the costs and benefits of investing in a technology when there is a lack of standards,” Linares said.

But some of these barriers are beginning to erode. When incentives to adopt technology are aligned with reimbursements, it can help, Hack explained. In California, a pay-for-performance program from the Integrated Healthcare Association rewards physicians who adopt IT. IHA, which includes six HMOs covering eight million members, bases a physician’s bonus on certain quality measures, patient satisfaction and IT use. IT implementation accounts for 20% of a group’s total score. The DOQ-IT project in California also could create a pay-for-performance model for small practices, Linares said.

If IPAs do decide to make IT investments, the key is integrating technology slowly and involving physicians in the process from the start, said Lanway of Hill Physicians Medical Group. He said it took several years to get physicians on board, which is one reason that Hill decided to start with electronic claims processing first. “Once you’ve got their attention, you start leading them through the next things that are important,” he said.

Brown & Toland’s Griest also predicted that market forces and national attention on the issue eventually would drive physicians to adopt IT tools. The key is for the early adopters of technology to be successful and create interest with other doctors.

“As more physicians go electronic, that will create the needed incentives,” she said.