We’ve all been asked the question…what is it that you do exactly?  For years my parents just tell people that I travel for a living helping hospitals with computers.  Although it is not completely off, it’s not exactly right.  Let’s face it, our career path is confusing to non HIT folks.  I thought I would share some tips and ideas that might actually engage family and friends during the holidays.

First lesson I learned, don’t mention Epic, MEDITECH, Cerner, Siemens, or any software company for that matter.  My entire family thinks I work for Epic.  I do not, nor have I ever.  I’ve had ongoing heated discussions with friends who insist Cerner did not buy Siemens, and that I don’t know what I’m talking about.  I try to avoid arguing with people as a general rule.  I just shake my head and say, ok.

Stay away from other HIT jargon like Meaningful Use, ICD-10, or Clinical Transformation.  Every year I’ve mentioned one of these, I have to listen to someone talk about ObamaCare, and how awful it is.  Really?  Did I mention anything about ObamaCare?  Sigh…

For the last couple of years my response has been simple.  “I manage consultants who help hospitals convert from paper to electronic medical record systems.”  I think this is pretty good, even though I actually originally built scheduling systems…but close enough.  If you are going to try to simplify what you do, keep it to something that people can relate to.

Here are some other good ones:

• “I’m a computer programmer who builds software for hospitals.” – Now this may once again suggest you work for Epic…but hey, whatever.
• “My company provides short term IT staffing support.” – I’m ok with letting folks think I work for a help desk.
• “I travel for a living working with hospitals who need help with their computer systems.” – I like this one, as it usually opens a discussion about travel instead of work. Much more interesting to most people.

Statements guaranteed to confuse everyone at the table, but may get a good laugh:

Regardless of whether your second cousins fiancee or your 19 year old nephew is inquiring, keep it short and sweet.  It’s an ongoing battle, but worth elaborating when you have the right audience.  Happy Thanksgiving!

No doubt consulting firms are looking at overhead expenses and cutting away.  The impact can be positive with less middle management and a return to focus on client delivery.  However, those consultants looking for full time salaried positions at a firm will be hard pressed to find a great bench benefit package.  Unlike the old days, were 90 days at full pay was the norm, firms are now pushing hourly project based employment with little to no benefits and with no bench policy at all.

I had hoped to list 15+ firms and their current bench policies.  I started collecting information over a month ago from friends and colleagues.  The struggle to collect the information was a combination of the majority of consultants being hourly project based, with no benefits, or simply not knowing their bench policy as it keeps changing.  Not surprisingly, the vast majority of consultants I spoke with said they don’t have a concrete bench policy, it’s at the discretion of the firm.

A simple snap shot:  smaller boutique firms are offering 30 to 60 days bench at full pay.  There is still a focus on employee culture, retention, and quality.  The bigger you go, you’ll find no bench policy and no interest in culture or retention.  Only wording that states “employment at the end of engagement is at the discretion of management.”  Obviously that is not really reassuring.  Several firms do offer a reduction in pay when on the bench.

I collected information on companies including Encore, Accenture, Beacon Partners, Logic, HCtec, CIS, ICG, HSM, ACS, and ESD.  I can’t share any complete summary because the majority keep changing their minds by either reducing days, altering % of salary pay, or removing the benefit all together.  With that said, don’t count on finding a firm that offers extended bench benefits.  30 – 60 days is the best you’ll find, and they’ll likely offer a lower base salary.  Average hourly pay for Epic consultants is $90.  I can’t believe I am saying this, but it seems hourly is the way to go.

For the bargain price of $14,000, you can now buy the just released report titled, “Epic Consulting 2014; The Bumper Crop of Epic Consulting Firms.”  The report rates 21 firms in various categories based on client survey responses.  An additional 12 firms are also showcased, although they do not qualify for rankings as they do not meet the minimum requirements for number of clients.  The big question is, what about all the other smaller boutique firms?

Smaller consulting companies aren’t included in these types of reports for two reasons.  First, they don’t want to pay the huge membership fee, it’s called overhead and causes increased bill rates and reduced salaries for employees.  Second, they would never qualify for rankings, because they focus on quality with small number of clients, not volume.  Ok, so coming from the largest Epic firm, I’ll say KLAS rating was important to me back then.  Do I sound bitter?  If it’s all about the consultant, which has always been my motto…then I was wrong to think that way even when working for the big companies.

Just today, EMR Daily News released a story stating that “experience is not a good predictor of performance for Epic consulting firms.”  I couldn’t agree more!  The story goes on to state that the number of engagements completed by a firm is not necessarily a correlation to client satisfaction of the Epic consulting services provided.  So great, 21 firms are all about volume, and pay KLAS to be a member so they can be ranked.  I’m sure that the dozens of other boutique firms not mentioned in the report provide just as high quality consultants, without the high price tag.  (I say this from experience, not just a whim).  My walk away, this report is about volume…not quality.

The last report released in 2012, Navigating the Sea of Epic Consulting Firms, ranked 15 firms.  So only 7 more firms have been added.  I was surprised that number was so low.  Companies listed in the 2012 report as Up and Coming Firms included:

What happened to these guys?  Here’s the facts folks.  There are so many firms out there touting their Epic capabilities, clients have tons of choices.  As a consultant, going with a top ranked firm may mean more project options, but certainly doesn’t mean quality.

Let me end with recognizing the winners though…in the catagory we all care about.   Orchestrate Healthcare has already released their news of being ranked #1  as the top-ranked vendor agnostic healthcare IT consulting firm.  This category is within Implementation Support and Staffing.  Probably the most coveted category as all 21 firms ranked are primarily staffing firms.  Congrats to all my colleagues at Orchestrate.

The latest report once again shows Delta on top and JetBlue on the bottom.  Discount airlines likes Southwest and JetBlue are on the bottom of this report, month after month, and year after year.  What does surprise me is AirTran coming in at #4 above US Airways and well in front of United. I wish I flew Hawaiian every week, it seems they are always on time.

In reading yet another posting on EMR consultant rates, it had not occurred to me the idea that the quality of consultants is a potential direct impact of reduced rates.  Check out http://concepcionguzman.com and read his story, “The #1 Reason EMR Consultants’s Rates Have Declined More than 35.9% Over the Last 5 Years.” I have to debate his findings, and look at this over the entire market space, not just go-live support and training.

No doubt the quality of resumes he suggests in his story, people who worked at Walmart and McDonald’s with only 2 go-lives under their belt, is something that is happening more and more.  But only in the go-live and training arena.  I assure you consultant firms are not hiring analysts, builders, testers, interface or report writers without the back ground required to fill these roles.  The overall statement that consultant rates are dropping because of the quality of consultant is skewed, as many firms don’t even provide go-live support services.  And for good reason!

I’ve written many stories on this topic, and continue to watch the consultant market become over saturated with firms and consultants.  This is the simple concept of supply versus demand.  A perfect example is this past week my firm received a need for a Resolute HB candidate.  So did about 40 other firms, as that client uses a Vendor Management System.  The VMS just sends the need out to everyone.  On sites like LinkedIn, you could see the posting over and over and over, looking for candidates.  The client will have the best of the best to pick from, and price point will be up to the consulting firm. With that in mind, it is my theory and suggestion that the decline in bill rate (and consultant compensation) continues to decline due to reduced demand in consultant needs and a high number of resources available.

Hiring practices for consultant services are clearly changing to meet demands.  First time consultants may help with meeting margins, but often directly impact quality of service.  KLAS ranks over 60 consultant firms, who all just poach from one another project after project.  The days of consultants being at the same firm for 5+ years is quickly fading.  It’s those firms that continue to focus on quality consultants at fair market bill rates that will succeed.  

What are your thoughts?  Seeing a reduction in your bill rate that is impacting your success?

This week several blogs shared an article that pointed to a reddit post about Epic’s salary, raise, and bonus structure. All kinds of interesting posts with an inside look can be found at http://www.reddit.com/r/epicsystems. I was especially interested in the salary piece, although other articles on being a mom while working at Epic or tatoos at Epic are very interesting as well.

The example given in the story from a TS hired in 2011 looks like this:

• Starting (June 2011): 60k
• Bonus (Holiday 2011): 8k
• Spot Bonus (Feb 2012): 1k
• TL Promotion (Mar 2012): No Raise/Bonus
• Year 1 Raise (June 2012): 76k (18%)
• Bonus (Holiday 2012): 6.5k
• Year 2 Raise (June 2013): 84k (10%)
• Left Epic August 2013

Let’s assume this is an average salary and bonus structure, for a job at Epic while living in the Madison, WI area.  It’s really a very competitive salary.  I went to Money.com to draw up a cost of living comparison.  A base salary of $85K in Madison translated to $110K base in Boston, MA (where I live).  That is not a far stretch from a typical consultant base salary.  Cost of living is much more reasonable in Wisconsin for sure.  But the average salary in Madison area is $51,000 based on indeed.com article.  Wow, that is a considerable difference and great salary for someone being hired out of college.

I am watching bill rates continue to drop by consulting firms to remain competitive.  Along with bill rates, salaries are also declining for Epic consultants.  While just 3 years ago my consultants averaged $138 bill rate, today I see a $122 average.  Average salaries have dropped from $130K to $118K (not including bonus).  Taking the cost of living into consideration here…I may just apply to work at Epic.  Don’t forget the benefit of cheese!!    

What are your thoughts?  Does Epic salary and bonus seem fair in the current market?

The big announcement this week, Cerner acquires Siemens. Well, not officially until 2015. This wasn’t a big surprise actually. Blogs including HISTalk have been suggesting this since May. Perhaps its the fact that there are only a handful of truly prominent Electronic Health Management vendors out there, and two of the biggest are merging. But the real question is what does this mean for consultants and our clients.

First, nothing is going to happen to Soarian customers. Period. So if you are supporting Siemens Soarian projects, no worries. The real impact would be to clients on an older Siemens system. They’ll obviously be forced into making decisions in the next year to either go with Cerner, or look elsewhere. It’s clear Siemens had no intention of updating its software, as they’ve lost more clients last year then all other vendors combined. In fact Siemens lost over 75 clients last year, followed by Cerner losing 35, and MEDITECH losing 25 (according to recent KLAS release). Notice no mention of Epic. They don’t lose clients.

The good news continues to be that Siemens Legacy support work will continue to grow. Remote help desk support for the next 3-5 years?! Sign me up! What will be interesting to watch is how Epic battles to keep it’s ability to tout that they service 51% of the US population. Cerner will no doubt impact continued growth of it’s client base by now having a jump ahead of the competition with current Siemens customers. What do you think? Good news or bad?

Three years ago my boss, at the time, suggested that I start a blog on travel tips, movies, restaurants, and hotels. Having spent the last 10 years on the road has certainly given me some great materials to write about. Having worked with so many consultants from all over the country has been such a fantastic experience, how could I not share. As you may have noticed, lately the blog has focused on consulting firms, vendors, and various changes happening in our industry. I hope you like the transition. I always want to remain positive and constructive, so please call me out if I slip.

I’m excited to share that I’ll be focusing on all of the above for the rest of this year and will be doing a summer themed group of articles.

Thank you for all your support over the years. As always, please share your thoughts and suggestions with me anytime.

Doug