David E. Bergman is the CEO and co-founder of ePreop. He practiced as an attending anesthesiologist at St. Jude Medical Center in Fullerton, California, where he also served as chairman for two years.
Dr. Bergman co-founded ePreop in 2008 to address the problems anesthesiologists experience related to patient care optimization, and daily administrative tasks surrounding their practice. Dr. Bergman spoke with Enhance Healthcare Consulting’s Anesthesia & OR Review in January 2019:
EHC: Describe your product(s) for the perioperative environment
Dr. Bergman: The ePreop software was created to make anesthesiologists’ lives easier. The reality is that we see patients every day and need to decide if it is safe to proceed without further intervention or optimization. The pressure to keep the OR moving is a factor, and there is no reason we should be put in that situation when we have so much data available to help guide patient readiness. Administrative burdens have also gotten so great that they take away the joy of practice. The software suite now has three platforms: SurgicalValetTM, AnesthesiaValetTM and Surgical CDITM that work to increase efficiency, reduce waste, improve surgical outcomes and increase quality scores. We are currently integrated into almost every major EHR system, including Cerner, Epic, Meditech, and Allscripts. This helps us provide services within the provider workflow.
EHC: How many facilities or groups utilize your product?
Dr. Bergman: We have around 400 clients today, and over 15,000 total users practicing in nearly 2,000 facilities. We have another approximate 15,000 users that submit their quality data through us for formatting and compliance. The majority of these users are anesthesiologists when using the quality improvement platform, and PAT RNs when using the full surgical care coordination suite.
EHC: How does the product benefit anesthesia groups?
Dr. Bergman: We don’t view groups purely as clients. ePreop partners with anesthesia groups when providing the AnesthesiaValetTM suite. We help them comply with MIPS and MACRA requirements through our quality application, capture patient experience data, streamline their billing capture and tracking, help them prepare for and compete in RFP processes, and support them when they need to show their value to contracting facilities. Our software allows them to take a more active role in managing perioperative care coordination and in capturing data to generate valuable reports, giving them a seat at the value-based table. With all of the group consolidation taking place in the market today, it is important for providers to show their value to ASC and hospital executives before a competitive evaluation takes place.
We are also formally partnered with the American Society of Anesthesiologists (ASA). This gives us direct insight into the regulatory environment changes and competitive market shifts. We are working together on multiple initiatives to ease the general administrative burden around practice, while positioning quality as part of a comprehensive strategy for group payments and negotiations that extend well beyond CMS.
EHC: Can you elaborate on how the ePreop software is able to capture comorbidities to improve Case Mix Index?
Dr. Bergman: ePreop’s Surgical CDITM platform supports comorbidity capture with point-of-care guidance and a full document management module. Case Mix Index is very important to surgical facilities today, and to anesthesia groups as well. The shift to value-based care drives greater reliance on risk stratification, and use of ePreop’s Surgical CDITM platform puts anesthesiologists in a unique position of being able to support accurate capture of comorbidities. Today, what frequently happens is that coders use their coding system, and then they query the surgeons asking for input after patients are already discharged. Surgeons find this process to be a nuisance, and things are regularly dropped. ePreop software reduces the number of queries the surgeons get, allowing the anesthesia group to take some of the workload off of their hands. We also believe the anesthesiologist is more well-suited to review and document accurate clinical descriptions. This leads to more appropriate reimbursement and better quality scores. Helping hospitals capture revenue that would otherwise have been lost is a great way to solidify a relationship and position the group as a partner.
We are partnered with Cerner, and they support our integrated solution as part of their model experience. We are also integrated with Epic, and work within their App Orchard program. Whether in an ASC, stand-alone environment, or embedded into the existing EHR, the goal is to provide everything they need for documentation, patient readiness, and quality all in one place. We typically see groups start off with quality, and we help them expand into other areas.
EHC: Since this information is captured as part of the preoperative preparation process, it is not always the anesthesiologist who is gathering the information. Who else would be involved in this process?
Dr. Bergman: If it is a full care coordination model, it is almost always the PAT nurses that are being actively engaged. We do have a lot of tight integration with EHRs, so data is being pulled from there as well to help triage patients, prepare them for surgery, and provide them with the right tests and patient education.
EHC: Who pays for the product?
Dr. Bergman: It’s a mixture. Usually, the group pays for the quality application, starting with AnesthesiaValetTM and then the hospital pays for the full SurgicalValetTM care coordination suite or Surgical CDITM application. That being said, we have seen groups take on the costs, and this can make a lot of sense in risk-sharing agreements, or just when the group wants to maintain more control around processes. We have also had some health systems that have purchased the AnesthesiaValetTM Quality Improvement platform. It is in both the surgical facility and the anesthesia groups’ best interest to make sure they coordinate and get it right. We help facilitate this coordination as part of our standard service.
EHC: What are the costs for use of the product?
Dr. Bergman: Anesthesia groups usually start with AnesthesiaValetTM and our MIPS/MACRA components, which typically start around $500 per provider per year. We have a lot of services that can impact cost, including patient experience surveys, integrated access to the schedule, EHR clinical integration, secure messaging, billing capture, revenue cycle support tools, and a simple HIPAA-compliant case tracker which eliminates sticker books or unencrypted mechanisms of tracking. We work to ensure the group is getting value, and this is our primary concern.
This quality platform participation also provides modular access for add-ons to the full SurgicalValetTM care coordination platform. The costs are dependent on EHR, case volume, and modules contracted. The full care coordination suite used in ASCs or hospitals may include online intake forms, patient portal integration, surgeon office scheduling, patient readiness tracking, documentation management, clinical decision support tools, enhanced recovery pathways, readmission prevention services, and surgical CDI.
EHC: Do you track and link the readmission module with actual data, and can you benchmark measures such as Length of Stay within your database?
Dr. Bergman: We try to, and it is not always easy because patients sometimes go to outside facilities, making it hard to track with 100% accuracy. We have seen some of our clients do a good job tracking, and they have gotten significant results after implementation. Length of Stay is typically a bit easier to track. We do collect a wide range of data, including LOS, post-op labs, medications, comorbidities, discharge diagnosis codes, and discharge disposition. With all the data mapping we have been doing over the past decade, we now are able to report very meaningful outcome metrics.
We have a large number of metrics we can benchmark nationally. We have one of the larger benchmarking databases in the country right now. We also recently were given the Anesthesia Quality Institute contract for their database management. We are doing some exciting things with the ASA to really help groups succeed in the value-based environment. Data and analytics are at the center of this approach.
EHC: What do you calculate as the ROI for your product?
Dr. Bergman: For anesthesia groups, there is a competitive need to capture and report data. We also help them avoid large penalties, and frequently get them bonuses through MIPS and MACRA that justify the ROI. Providers using our case tracking platform have paid for the entire system with the capture of lost revenue. Groups that are in ACOs are using us more and more after recognizing they have no say without their own access to data. Seeing anesthesia groups get left out despite being part of these bundled payments and ACO programs is a serious issue. They can take control of their groups’ message by owning the data and reports. These things become increasingly important when an RFP or stipend discussion comes up.
With the hospitals, ROI is based on standard types of metrics, like postoperative outcomes, decreasing delays, cancellations, time in the PACU, Case Mix Index, Length of Stay and readmission rates.
EHC: Do you have plans for any new products or upgrades to existing products that readers should be aware of?
Dr. Bergman: We have such a large volume of data now that we are really focused on our analytics and tying in some real machine learning tools and AI. We have been doing great things with using machine learning and procedure mapping. The next phase is looking at predictive modeling around outcomes based on patient risk factors. It is a really exciting time, and I am hoping we help lead a new way to deliver patient care in the perioperative arena.
EHC: What do you see as the shifting needs for technology in the perioperative environment over the next 2 to 5 years?
Dr. Bergman: I do think in the next two to five years, it is going to be all about access to data — how we are using the data, and what type of value we are providing these organizations, whether it is a group, hospital or ASC. Right now, machine learning and artificial intelligence (AI) is about 90% hype in healthcare. Everybody is claiming they have it, but what they are really describing is core analytics. In two to five years, processes will truly be driven around machine learning and AI. It is already impacting the way most healthcare IT executives are approaching their long-term growth strategy. Hospital executives are currently more focused on tangible things, as they have to worry about near term financial performance. In the future, though, everything is going to be driven by machine learning and AI. We are trying to make sure that we are positioned properly for this transition.
EHC: Thank you, Dr. Bergman. We greatly appreciate your time.