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U.S. Physicians Practice Management Systems

(PPMS) Markets—Scheduling; Reporting; Billing

and Claims for Ambulatory Care Providers

Table of Contents

C h a p t e r 1

Executive Summary

Executive Summary 1-1

C h a p t e r 2

Total U.S. Physicians Practice Management Systems Market

Physicians Practice Management Systems Market Profile 2-1

Overview 2-1

Market Segmentation 2-3

Stand-alone and Integrated Systems 2-4

Advantages of Integrated PPMS Systems Over the Stand-alone Systems 2-5

Revenue Forecasts and Analysis 2-5

Research Methodology 2-5

Total U.S. PPMS Market Revenue Forecasts and Analysis 2-6

Revenue Forecasts by Size of Practice 2-8

PPMS Market Penetration Among Physicians 2-10

Existing Physicians Using Stand-alone Practice Management Systems 2-11

Existing Physicians Using an Integrated Practice Management System 2-11

Market Engineering Measurements 2-11

Market and Technology Trends 2-13

PPMS Integrated with EMR Systems 2-13

Application Service Providers (ASP) 2-14

Adoption Rate of Technology Among Physicians 2-14

Graphical User Interface (GUI) 2-15

Wireless Devices 2-15

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Industry Challenges and Strategic Recommendations 2-16

Industry Challenges 2-16

Broader Perspective 2-16

Specific Industry Challenges 2-17

The Number of Claims, From the Physicians, Being Denied and Cancelled by the Payer Companies Has Been

Constantly Increasing in Recent Times 2-18

The Adoption Rate of the Technological Innovations in Healthcare Information Technology

is Lower Than Expected Among the Physicians 2-18

More Number of Physicians Hesitate to Use Internet and Web-based Systems as a Part of PPMS

Due to the Lack of Confidence, Safety, and Privacy 2-18

Physicians are not very Comfortable Either to Use Technological Solutions or Change Over to

a Newer System from Their Older PPMS 2-19

The U.S. PPMS Vendors Architecture is Highly Competitive 2-19

Strategic Recommendations 2-20

Physicians Should be Trained in Effective Claims Submissions and Claims Denial Management Systems 2-20

Increase Adoption by Reducing Claims Denials 2-20

Build Confidence Among Physicians by Including a Secure and Reliable e-Mail as Part of the PPMS Offering 2-21

Provide Well-planned, Intensive Training to Help Physicians Adapt to Newer Systems 2-22

Gain Competitive Advantage by Developing Total Cost of Ownership and Highlighting Other

Favorable Benefits and Features 2-23

C h a p t e r 3

U.S. Physicians Practice Management Systems Market Analysis

Overview 3-1

Need for a Practice Management System at a Physicians Office 3-4

Classification of Physician Practices in the United States 3-5

Implementation of New Practice Management Systems 3-6

Turnkey Model 3-6

Outsourced Model 3-6

Market Drivers 3-7

Reducing claims reimbursements, by insurance payers, for paper submissions due to high probability of errors 3-7

Low probability of errors and quick submission of claims through electronic systems 3-8

Rapidly Changing Government Mandates and Regulations on the Physicians Practice Management Solution 3-9

Increasing Interest Among Physicians for Wireless and Web-based Practice Management Systems 3-9

Increasing Competition in the Healthcare Field Among the Physicians, Forcing Them to Stay Ahead

in Treating Patients 3-9

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Market Restraints 3-10

Replacing a paper-based practice management by electronic system or replacing a stand-alone system

by an integrated system has the risk of loss of sensitive health record data of the patients 3-11

Cost Constraints Hinder Adoption Among Small-sized Physician Practices 3-11

Updates and Annual Maintenance Fees Constrain Adoption Among Medium-sized Physician Practices 3-12

Complexity of System Cycles, Huge Investment, and Security Issues of the Data Delay Adoption

Among Large-sized Physician Practices 3-12

Difficulties in Developing Consolidated Practice Management System Solutions Negatively Affect Revenues 3-12

Confusion Among Physicians in Choosing a Practice Management Solution Delay Adoption 3-13

Revenue Forecasts and Analysis 3-13

Revenue Forecasts for the Stand alone solutions PPMS Market 3-13

Revenue Forecasts for the Integrated PPMS Solutions Market 3-15

Physician Practice Demographics 3-16

Forecasts for Number of Physicians in Various Sizes of Practices 3-16

Number of Full-time Physicians Working in Physician-based Practices 3-16

Small-sized Physician Practices 3-18

Medium-sized Physician Practices 3-18

Large-sized Physician Practices 3-18

Market Penetration of PPMS Among Physicians 3-18

Forecast by Size of Practice 3-20

Pricing Forecast and Analysis 3-22

Average Price per Physician 3-22

Average Price per Practice 3-23

Small-sized Physician Practices 3-24

Medium-sized Physician Practices 3-24

Large-sized Physician Practices 3-24

Competitive Analysis 3-25

Competitive Structure 3-25

Acquisitions of Physician’s Practice Offices 3-26

Highly Competitive Market Scenario 3-26

Consolidation 3-26

Name recognition 3-27

Vendor Demographics 3-27

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Market Share Analysis 3-28

Product Overview 3-29

Appointment Scheduling 3-31

Patient perspective 3-31

Appointment Cancellations 3-32

Claims and Billing 3-32

A New Billing System 3-32

Training on New Billing Systems 3-33

C h a p t e r 4

Appendix

Decision Support Database 4-1

Number of Practicing Physicians 4-1

Number of Specialty Centers 4-4

Per Capita Healthcare Expenditure 4-4

Total Healthcare Expenditure 4-7

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List of Figures

Ch a p t e r 2

Total U.S. Physicians Practice Management Systems Market

2-1 Total Physicians Practice Management Systems Market:

Revenue Forecasts by Market Segment (U.S.), 2002-2012 2-6

2-2 Total Physicians Practice Management Systems Market:

Revenue Forecasts by Size of Physician Practice (U.S.), 2002-2012 2-8

2-3 Total Physicians Practice Management Systems Market:

Market Penetration of PPMS among Physicians (U.S.), 2002-2012 2-10

2-4 Total Physicians Practice Management Systems Market:

Impact of Industry Challenges (U.S.), 2006-2012 2-17

2-5 Total Physicians Practice Management Systems Market:

Strategic Recommendations (U.S.), 2006-2012 2-20

Ch a p t e r 3

U.S. Physicians Practice Management Systems Market Analysis

3-1 Physicians Practice Management Systems Market:

Market Drivers Ranked in Order of Impact (U.S.), 2006-2012 3-7

3-2 Physicians Practice Management Systems Market:

Market Restraints Ranked in Order of Impact (U.S.), 2006-2012 3-10

3-3 Physicians Practice Management Systems Market:

Revenue Forecasts for Stand-alone PPMS Solutions (U.S.), 2002-2012 3-13

3-4 Physicians Practice Management Systems Market:

Revenue Forecasts for the Integrated Front- and Back-office Solutions (U.S.), 2002-2012 3-15

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3-5 Physicians Practice Management Systems Market:

Number of Physicians by Size of Practice (U.S.), 2002-2012 3-17

3-6 Physicians Practice Management Systems Market:

Penetration Rate by Size of Physician’s Practice (U.S.), 2002-2012 3-19

3-7 Physicians Practice Management Systems Market:

Number of Physician Practices Using PPMS (U.S.), 2002-2012 3-20

3-8 Physicians Practice Management Systems Market:

Average Price per Physician by Type of Installation (U.S.), 2002-2012 3-22

3-9 Physicians Practice Management Systems Market:

Average Price of PPMS Installation per Practice (U.S.), 2002-2012 3-24

3-10 Physicians Practice Management Systems Market:

Competitive Structure (U.S.), 2005 3-25

3-11 Physicians Practice Management Systems Market:

Market Share of Major Market Participants (U.S.), 2005 3-28

3-12 Physicians Practice Management Systems Market:

Products Offered by Major Market Participants (U.S.), 2005 3-30

Ch a p t e r 4

Appendix

4-1 Decision Support Database:

Number of Specialized Medical Practitioners (World), 1999-2006 4-1

4-2 Decision Support Database:

Ambulatory Surgical Centers (United States), 1999-2011 4-4

4-3 Decision Support Database:

Per capita Healthcare Expenditure in USD (World), 1999-2006 4-4

4-4 Decision Support Database:

Total Healthcare Expenditure in Billion USD (World), 1999-2006 4-7

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List of Charts

Ch a p t e r 2

Total U.S. Physicians Practice Management Systems Market

2.1 Total Physicians Practice Management Systems (PPMS) Market:

Evolution of Practice Management Systems Solution (U.S.), 1970-2010 2-3

2.2 Total Physicians Practice Management Systems Market:

Revenue Forecasts by Market Segment (U.S.). 2002-2012 2-7

2.3 Total Physicians Practice Management Systems Market:

Revenue Forecasts by Size of Physician Practice (U.S.), 2002-2012 2-9

2.4 Total Physicians Practice Management Systems Market:

PPMS Market Penetration Among Physicians (U.S.), 2002-2012 2-11

2.5 Total Physicians Practice Management Systems Market:

Market Engineering Measurements (U.S.), 2005 2-12

Ch a p t e r 3

U.S. Physicians Practice Management Systems Market Analysis

3.1 Physicians Practice Management Systems Market:

Essential Components in an Integrated Front- and Back-office PPMS Solution (U.S.), 2005 3-2

3.2 Physicians Practice Management Systems Market:

Workflow in a Physician’s Office (U.S.), 2005 3-4

3.3 Physicians Practice Management Systems Market:

Major Reasons for Claims Denials by Insurance Payers (U.S.), 2005 3-8

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3.4 Physicians Practice Management Systems Market:

Revenue Forecasts for Stand-alone PPMS Solutions (U.S.), 2002-2012 3-14

3.5 Physicians Practice Management Systems Market:

Revenue Forecasts for the Integrated Front- and Back-office PPMS Solutions (U.S.), 2002-2012 3-15

3.6 Physicians Practice Management Systems Market:

Number of Physicians by Size of Practice (U.S.), 2002-2012 3-17

3.7 Physicians Practice Management Systems Market:

Penetration Rate by Size of Physician’s Practice (U.S.), 2002-2012 3-19

3.8 Physicians Practice Management Systems Market:

Number of Physician Practices Using PPMS (U.S.), 2002-2012 3-21

3.9 Physicians Practice Management Systems Market:

Vendor Demographics (U.S.), 2005 3-27

3.10 Physicians Practice Management Systems Market:

Market Share of Major Industry Participants (U.S.), 2005 3-29