The Tech Doctor: Vendor Hardball

In all relationships, there will be disagreements. Sometimes, these matters can grow from a simple disagreement to a complete impasse. And the scenario can be painful when the impasse is between your practice and a major vendor who won’t budge on an issue.

Perhaps insurance laws in your state have changed, and you need your vendor to make modifications to how your practice management system stores and preps claim information. Without the modification, this change will cost you increased staff hours - but your vendor can’t or won’t make the change happen.

Or, perhaps you’ve opened up a new location in another region of your state, and you previously bought your phone system from a vendor with that plan in mind. But now your vendor is telling you it’s impossible to use your existing system to create interoffice dialing extensions to the new location. What do you do?

Be realistic

Before you make any moves, step back and assess the situation. Think about what you’ve asked your vendor to do, and then ask yourself objectively: “Is this a realistic request?

I recall a case where a multispecialty practice wanted to bring dentists into the practice. The practice had never operated a dental practice. Before the ink was dry on the contracts, however, the core practice found out from their primary software vendor that the current version of their existing billing software wasn’t equipped to handle dental billing. The practice demanded the vendor provide a remedy, but the vendor had never produced a dental billing application and didn’t have any solution to offer.

The simple remedy, of course, would have been to allow the dental group to continue billing using their existing software package. But the impasse between the practice and the vendor became so intense, the practice lost sight of what was realistic. Both sides were stuck and nobody won.

But it doesn’t have to be that way. If your practice requires something of a vendor, first review your expectations and determine if they are realistic. Asking your vendor to do something that is clearly not in their line of services, or is simply unrealistic serves no purpose. As a safeguard, run your thoughts by a respected peer in the professional community. Often, a fresh perspective can provide insight that you may not be able to muster, being so close to the problem.

Strength in numbers

If you have given yourself a reality check and still feel your requests are reasonable (and your vendor still won’t comply), look for strength in numbers.

Seek out peer organizations, user groups, and Internet forums such as electronic discussion boards. If your issues surround computer hardware, software, or other technical issues, it’s likely someone else has already experienced the same problem, and it’s likely they posted their experience online.

Also, do your research. There are cases, particularly with software vendors, where custom software modifications have been created for larger clients, but those modifications weren’t put out for general release to all users. For example, a small client of a particular vendor was repeatedly denied their request to have their EMR product modified to a more useful format. A chance online encounter revealed that a much larger client had encountered the same problem, with the same vendor, and the vendor had provided a custom modification to remedy the issue. It only took a brief phone call from the smaller client, and a reference to the customization performed for the larger client, to get the same fix.

Think for yourself

Remember that you are your own best consultant. You know your problem intimately, so don’t be afraid to get creative, and venture into areas outside your comfort zone. Just because a vendor tells you that it’s impossible for them, doesn’t mean it’s impossible for you.

Case in point: A local practice had a series of physical chart rooms, which had been bar coded by a legacy software system. The practice switched to a new practice management system, and due to a variation in the number of characters the new software package used for the medical record number, they would no longer be able to use their bar code scanners. The medical records manager painfully watched her staff give up their speedy scanners and revert to manually keying in the chart number one digit at a time. The software vendor’s only suggestion was a complete relabeling of every chart jacket with a new bar code to accommodate the change in field length. A lot of work, to say the least.

Two weeks later, the vendor visited the practice and was surprised to find the medical records staff breezing through return chart stacks with their bar code laser blazing again. When questioned, it turned out the medical records manager had found a software package online for virtually no cost that allowed her to “pad” the input from the old bar codes with extra zeros on the left, resulting in a scanned bar code that matched the new software’s required field length. Bravo! The vendor’s IT experts had been outdone by a rogue records manager.

Take it up a notch

While it is a dangerous card to play, you may want to remind your vendor this is a free market economy. Perhaps a simple reminder that their competitors are still lurking outside your doorstep and are more than willing to make something happen, in terms of meeting your immediate needs. Equally important with regard to this strategy is not to play this card often. If you make this empty threat too often, and the vendor knows you are bluffing, the tactic loses all effectiveness.

A more diplomatic approach might be to simply move up the chain of command. “Escalation” has almost turned into a magical word in the industry, and seems closely related to “Open Sesame” - opening the doors to more senior staff on the vendor side. If you reach a point of impasse with your contact, very respectfully ask that he escalate the issue to his management group. Done appropriately, with respect, your rep likely will be happy to comply (and take some heat off himself), and get you in touch with his managers. His managers may either reinforce the reasons behind the vendor’s decision/inability to comply, or they might be able to make an exception for your practice.

Regardless of how long your group has held a relationship with a vendor that you find yourselves at odds with, keeping your cool and assessing the situation may still get you what you want in the end. Even if it doesn’t, most of your vendors want to maintain a positive, long-term relationship with your practice, or they lose money.

Recognize that in most cases, vendors are there to help. Treat them with respect, and be realistic in your demands. Don’t be afraid to stomp your feet and demand escalation, but do it in a professional manner. Remember: You may still get more flies with honey.

Jonathan McCallister is a client-site IT manager for a major healthcare consulting firm, and he is currently assigned to a 140-physician practice. He has worked in healthcare IT management for more than eight years and in general IT management for more than a decade. He can be reached via physicianspractice@cmpmedica.com.

This article originally appeared in the January 2009 issue of Physicians Practice.