Adoption of an EHR

There are any number of reasons why physician practices should adopt Electronic Health Records (EHR). Often it is in order to streamline claims administration and payment, or to more easily share and exchange records in a multi-specialty practice. However, with the passing of the ARRA HITECH act within the stimulus bill, it is more and more often because of the incentives and penalties associated. But there are other, sometimes surprising, benefits that accrue when a practice begins to effectively use one of the newest products available on the market

In today’s media environment a focus on financial penalties and fear of failed implementations garner the lion’s share of attention. However, as Hielix continues to work directly with physician practices and provide strategic council to our channel partners, we see practices realizing vital, yet hidden implementation benefits. These include reduction of errors, reduction of risk and the reduction in the level of vulnerability to systemic and human error.

Based on our experience with ambulatory physician practices, our team has uncovered five hidden benefits that can be expect by carefully selecting and implementing an EHR product:

1. Increased Operational Flexibility
2. Greater Billing Control
3. More Accurate Reimbursement
4. Reduced Risk of Undercoding
5. Waiting Room Efficiency

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Benefit One – Increased Operational Flexibility

The first hidden benefit is the flexibility that comes when the EHR system can be accessed and used remotely. When a clinician has access to the complete patient chart and record from almost any location at any time, a major constraint on the way he or she practices medicine is removed. Previously, charting and chart consultation happened in the care environment – the physician’s office or clinic. If an urgent call comes in from a hospital or pharmacy after hours, in most cases the clinician would have to return to the location of the paper chart to consult its content. If a physician was rounding in a hospital setting, details of the consultation necessary for billing the insurance company were typically captured on a notepad, or any small piece of paper until the physician returned to the office and could deliver the notes to his office or billing manager.

This is the source of anecdotal tales told by billing clerks of cardiologists and other specialists who regularly see patients in acute care settings: “He dumped out two dozen small scraps of paper with notes hastily scribbled, crumpled and days or weeks old and expected me to build a Superbill!” When the physician can capture information at the point of care, regardless of the setting, claims can be more accurately and timely submitted, which results in financial benefit to the practice. Moreover, the physician with a young family can leave the office at a reasonable hour, enjoy dinner with his or her children, participate in putting them to bed, then finish charting from a laptop or iPad at his/her leisure later in the evening.

Clearly the availability of the full patient record significantly reduces the opportunity for error. Not only can the clinician directly access the full detail of the patient’s chart (including current problems, labs, medications and symptoms) but he or she can also validate diagnoses, review whether or not prescribed medications have been dispensed, and identify the patient not only by demographic data, but also by photographic image, which can be extremely important.

Benefit Two – Greater Billing Control

Another significant benefit to ambulatory practices from the implementation of an EHR is bringing the billing function back into the office from a third party billing service. Over the past ten years, the majority of very small physician practices (three or fewer physicians) have contracted with third party companies who provide claims compilation, administration and collection services. Often these companies also manage the patient accounts receivable on behalf of the practice as well. The going rate for this service is typically a small percentage (5% - 7%) of collections as a fee. Once a practice has outsourced this service, it is typically very hesitant to consider bringing the billing function back into the operation.

However, the newest EHR software versions have features focused specifically on streamlining the billing process, including robust eligibility checking that can prevent many errors, real time updates to Medicare and other payer reimbursement rates. In some cases, this will also include artificial intelligence supported and pre-scrubbing of claims. Most small practices are surprised to learn that the processing of claims has become a highly automated and electronic process that they can manage inside the operation without any increase in personnel resources. Not to mention at a much lower cost than the 5% - 7% they were paying previously. It’s not unusual for physicians and practice managers to dispute these gains until after the EHR has been implemented and they can see the process for themselves. However, with margins so thin for ambulatory practices, every point gain or profitability means a lot to both the practice and physician.

Benefit Three – More Accurate Reimbursement

Another hidden benefit closely related to the ease of processing billings and claims is an automated E&M (Evaluation & Management) code point counter. Medicare and most other insurance companies use these codes to determine the amount that a practice will be reimbursed for a specific examination. The higher the point count, the higher the code and subsequent reimbursement. In the event an insurance company audits or rejects a claim, this point-based code can be documented to validate the claim. In some of the new EHR systems, this point count and rationale is tracked for each patient encounter, and can be viewed or produced as a document that can be used for this purpose. For certain specialties this feature can be a significant time saver for staff that would ordinarily need to produce this documentation manually. In addition, the software works as an objective determinant of the code, versus the doctor’s subjective judgment regarding the appropriate code.

Benefit Four – Reduced Risk of Undercoding

In addition to ease of processing billings and claims, there is a second hidden benefit to E&M coding tracking and verification. This is in reducing the risk of under-coding a specific patient encounter. Many small practice physicians are hesitant to submit claims for the higher-level counter codes. This hesitation can result in an under-coding of claims and potential loses of reimbursement revenue. Over the course of a month where a typical small practice with one physician and two mid-level clinicians might see seventy to eighty patients in a day, under-coding can rapidly add up. When the code is objectively validated by the software, small practices report very little worry concerning the submission of the higher level codes while capturing the fair full value of the patient encounter.

Benefit Five – Waiting Room Efficiency

Finally, in an office without a comprehensive EHR system, physicians can often lose track of the status of the waiting room. Typically there is little physical visibility between the waiting room and the examination rooms, which are often behind closed doors to the waiting room and front desk area. Sometimes the practice administrator’s office is also off the main corridor and behind the waiting room doors. Without traffic tracking provided through an EHR or practice management software application patient backups don’t get noticed until they are very severe. Over time this can result in the lost appointments during a given day, and if persistent, in the loss of patients. With patient check-in and waiting tracking, a patient can be told what to expect in terms of a wait when he or she arrives. If the projected waiting time is unacceptable to the patient, then the visit can be rescheduled. If the backup is visible throughout the practice to all clinicians, the staff can also react accordingly and make proactive efforts to speed up patient flow.

The ambulatory practice business environment is an environment where each mistake or misstep can have consequences to both the overall care of patients and the bottom line of the practice. The proper evaluation and adoption of an EHR system adds immediate, visible benefit to the practice and allows for the collection of federal reimbursement funds. However there are other, less visible benefits that can impact the success of the implementation and the sustainability of the practice. In order to uncover these benefits, physician and practice administrators should be prepared to find a partner who can help select the EHR appropriate to the individual practice and stay involved throughout implementation so the ultimate value of the software can be achieved.