Urology of San Antonio Realizes a Dramatic Return on Investment with EMR Solution

With revenues hitting a plateau, Urology of San Antonio boldly implemented an electronic medical record (EMR) and practice management system. As a result, the practice increased revenue by raising patient throughput, captured missed charges by optimizing medical coding, and cut costs drastically by eliminating paper processes and reliance on transcription services. Urology of San Antonio broke even on its investment 10 months after go-live and improved its financial outlook and quality of patient care.

Challenge

When the physicians of Urology of San Antonio met to discuss their practice’s future financial status, they concluded that they needed to cut costs and enhance existing revenue streams to maintain or improve profitability. The practice decided to meet this goal by implementing an EMR solution. Although a significant investment in human and financial capital would be required, the group realized that an EMR system would boost productivity and yield positive long-term financial benefits.

At a Glance

Organization: Urology of San Antonio, San Antonio, Texas

– 18 physicians
– Six clinical offices
– One surgery center
– Centralized business office

Solution Spotlight

– Practice Partner® Patient Records
– Practice Partner® Appointment Scheduler
– Practice Partner® Medical Billing

Critical Issues

– Maintaining and improving profitability
– Reducing costs associated with paper charts and paper-driven processes
– Improving coding accuracy
– Enhancing clinical efficiency, patient care and service

Results

– $150,000 annual savings in transcription costs
– $144,000 annual savings in labor costs
– $40,000 annual savings in paper supplies costs
– $360,000 annual revenue increase resulting from coding efficiencies
– Increased daily visits

Read the full case study: “Urology of San Antonio Realizes a Dramatic Return on Investment with EMR Solution.”

Mobihealthnews, an online news site that chronicles the mobile revolution within the healthcare sector and tracks the rise of electronic health records, recently reported that Gartner analysts don’t see the HealthcareIT revolution centering around the emergence of wireless technologies, such as the recent applications may hospitals are adopting announced in a Computerworld report here. 

Gartner analyst Wes Rischel says that these new wireless technologies are “incremental advancements”, and that the real revolution in HealthIT will likely come from elsewhere: “increased deployments of electronic medical records systems and the resulting improvements in data-sharing among organizations.”

“First, Rischel threw cold water on wireless health applications by pointing to the tepid uptake of RFID tracking for medical devices. Sure, they both use some form of wireless technology, but how does RFID’s uptake relate to the potential of a wireless blood pressure cuff or connected blood glucose monitor? It doesn’t. 

“Next, Rischel said that technologies like the heart sensor patch that Dr. Eric Topol demonstrated at the CTIA conference are “incremental advances.” “The real revolution in health care IT, Rischel said, will likely come from something else: increased deployments of electronic medical records systems and the resulting improvements in data-sharing among organizations.” 

“The federal government’s effort to encourage all physicians and hospital groups to deploy electronic medical records (EMRs) may one day come to fruition. I’m in the camp that believes it will. While the challenges for EMR interoperability are staggering, the end result will correct a massive problem of inefficiency. And it’s a long overdue correction.

“From a patient’s perspective, though, enabling different hospitals and clinics to share medical records is far from “revolutionary”. In fact, it’s more outrageous that the industry is still unable to do it fluidly. Sure, it will lead to better care for patients since all of their caretakers should have access to the same information leading to fewer repeated tests, fewer mistakes should follow and so on. That’s still just correcting problems, though. 

“The healthcare revolution will be patient-centered, participatory health care — anytime and anywhere. Wireless cardiac sensors like the one Topol demonstrated last month will lead to improvements in data sharing — not just among organizations — but among patients and caregivers, too. That’s the mark of a new era, not just a more efficient version of the old one.” 

Read the full article here.

HIMSS recently published its approved definitions of ‘meaningful use of certified EHR technologies,’ as outlined in the American Recovery and Reinvestment Act of 2009 (ARRA):

“Approved by the HIMSS Board of Directors, the definitions resulted from consensus-building effort with input from HIMSS members (73 percent of which work in end-user settings), and the public at-large.  HIMSS represents more than 20,000 individual members and 350 corporate members.

In summary, HIMSS recommends the following:

1. To ensure continuity, recognize CCHIT as the certifying body of EHRs.
2. To achieve incremental maturation of “meaningful use,” adopt metrics that can be reasonably captured and reported beginning in FY11/2011,* and then made increasingly stringent using intervals of not less than two years.  HIMSS’ definitions include specific metrics to enact, in phases, over a multi-year period.
3. To bridge existing gaps in interoperability of health information, coordinate with HITSP and IHE to create new harmonized standards and implementation guides.
4. Reconcile the gap between “certified EHR technologies,” “best of breed,” and “open source” technologies.

Washington Hospital Uses EHR to Reap Clinical and Financial Gains for Chronic Disease Management

Managing quality improvements in chronic disease treatment is a challenge for any physician practice, but even more so in a family practice residency where much of the clinical staff includes residents in constant transition. To improve the continuity of care provided by its three office family medicine residency, Washington Hospital implemented a fully integrated electronic health record (EHR) from McKesson, overhauled processes within the practice, and enlisted support from a research network to benchmark quality measures. The transformation has helped the residency enhance patient care and benefit from a regional pay-for-performance program, increasing annual revenue by $50,000.

At a Glance: Organization

Washington Hospital, Washington, Pa.
– 24 residents
– 15 faculty
– 58,000 visits per year

Solution Spotlight

– Practice Partner® Patient Records
– Practice Partner® Appointment Scheduler
– Practice Partner® Medical Billing

Critical Issues

– Limited continuity of care and missed opportunities for managing chronic diseases
– Low level of financial return on quality bonuses

Results

– Instituted process changes using the EHR that empowered administrative and nursing staff to take an active role in diabetic disease management
– Significantly improved performance against quality standards for diabetic patients as measured by a national research organization
– Maximized pay-for-performance incentives offered by primary payor, resulting in an additional $50,000 per year in quality bonuses

Making the transition to an electronic medical record (EMR) is a major undertaking for any clinic. It involves an expenditure of both human and financial capital, and also requires a fundamental change in the way that a clinic conducts itself. This raises a very simple but profoundly important question: does it make sense from a business perspective?

There is strong evidence to suggest that making the transition to an EMR is one of the most intelligent business decisions that a practice can make. The basis of our argument is derived primarily from the experience of Physician Micro Systems’ customers who use Practice Partner® Patient Records. Determining whether an electronic medical record makes sense in a medical office is not strictly a numbers game. It is a function not only of finance, but also of the quality of services provided and the effect it will have on the clinical and administrative staff.

We will look at four specific categories within a medical office where an EMR can make a significant difference, and within each category we will provide concrete examples of benefits realized by clinics across the country. Each example has either top line (=increased revenue) or bottom line (=increased profitability) implications for the clinic. Keep in mind that the EMR is a tool with a broad set of features and capabilities that are optimized when the clinic is able to fully transition to the electronic chart (as opposed to running dual paper and electronic systems).

The categories are as follows:

- Cost Reduction
- Revenue Enhancement
- Improved Administrative Efficiency
- Improved Clinical Efficiency, Patient Care, and Service

Read the rest of the white paper: “The Dollars and Sense of Electronic Medical Records: The bottom line case for an EMR.”

Now that the media hype is abating and the HITEC funding has been approved, where does the industry really stand on EMR adoption? A recent report found that, despite the significant funding available to physicians to purchase and implement EMRs, Medicaid penalties, not incentives, will boost EMR adoption:

“Provisions in the stimulus law that call for cuts in Medicare reimbursements, rather than a multibillion-dollar incentive program, will do more to push the adoption of electronic medical records among hospitals and doctor practices by 2015, according to a report from PricewaterhouseCoopers’ Health Research Institute. The survey, which involved 100 hospital CIOs, also said that providers need to evaluate whether they should start deploying EMR systems before details such as “meaningful use” and certification are finalized.”

Whatever it is that spurs adoption, whether the desire to improve patient care, the need reduce clerical time and errors or the potential for advancement in treatment possible by aggregating patient information in electronic data sets, widespread adoption will be a challenge given the current EMR usage rates nationwide. A recent study from the New England Journal of Medicine points out that hospital EMR adoption rates are still abysmal:

“Think the prospect of an IT stimulus has gotten hospitals all hot and bothered over idea of implementing EMRs? Well, not really, if a new study published by the New England Journal of Medicine is on target.

The study concluded that only about 8 percent of the 3,000 hospitals studied by researchers used even a basic EMR in a single unit, which included nurse or physician notes. And only 1.5 percent of non-federal U.S. facilities use a comprehensive EMR. (Fierce Health IT)”

Another release from SK & A Information Services, Inc. reports that 67% of physicians still do not use an EMR, even though another report states that EMRs were named a top priority in an HIMSS survey of healthcare information professionals:

“Implementing electronic medical records has become the top priority for senior healthcare information professionals, a major US survey has shown.

“The survey revealed that although recession is being felt in the US, healthcare and healthcare IT are still expected to grow over the coming year.

“The 20th Health Information and Management Systems Society (HIMSS) annual survey of chief information officers found that 31% of the 304 participants said their number one priority is to ensure their organisation has a full EMR.”

Read more about the report here. Obviously there is huge opportunity for EMR vendors to connect with physicians, provide them with the information they need to select and implement and EMR and push for the widespread adoption this funding is designed to instigate. How quickly things get moving, however, will be largely dependent on how quickly the newly appointed government funding overseers can agree on next steps, define regulatory standards and begin funding distribution. More coverage as this issue progresses. For more infomation about certified EMRs, current funding requirements and what physicians need to do to begin selecting and implementing an EMR software under the current legislative language, click here.

In addition to improving accuracy in medical records and quality of care in individual hospitals and practices, widespread adoption of EMRs could have the potential to improve quality of care on a much larger scale.

As more physicians and hospitals adopt EMRs and medical records are systematically moved from pieces of paper to indexable, analyzable data sets, the healthcare industry would have increased capacity to study trends, treatments, and effects at a level never possible before.

As this commentary entitled “Electronic Medical Records Could Help Find Cures, Speed Progress, Cut Costs” points out:

“Electronic medical records (EMR), like health insurance, benefit from being spread over the widest pool possible. A system that aggregates and cross-references data from hundreds of millions of patients can find statistical evidence far more efficiently than today’s statistical modeling for health problems and solution improvement.

“Allowing for non-identified EMR sharing across the system creates a universal pool of data in which drug side-effects, treatment failure or success rates, disease history, specific organ damage or healing, and all sorts of incidence of drug interactions and health specifics can be cross-referenced, spurring a massive amount of data-rooted research and improving quality of care and treatment success rates.”

Although the industry is far from reaching this point, due to debates about privacy and the potential implications of centralizing health data, the point is good food for thought. Access to relevant data and the ability to analyze large sets of statistically significant data could speed research and healthcare advancements by leaps and bounds.

Another commentary from Fast Company states:

“The dream of interoperable EMRs, which would create a mass database where we can detect epidemics and study drug interactions, has yet to be realized. Financial incentives from the government and private insurers may help, but there are other hurdles to overcome.”

“The fundamental problem is that doctors get paid for service, not wellness. The ideal is to find real patterns in health, safety, and wellness in EMRs, and reward accordingly. That requires the widespread adoption of a truly interconnected system that doesn’t quite exist yet. Even in the widely used VA EMR system, some data are recorded and shared, and some aren’t. Once we solve that problem, it will take the determination of all parties — including the government, through reform to Medicare and Medicaid — to put in place a new way of paying doctors and health systems.”

Below are some commonly asked questions regarding the economic stimulus funding and what physicians need to do to qualify for the funding:

Who or what kinds of organizations will benefit from the healthcare IT incentives?

The incentives primarily benefit hospitals and office-based physicians. They are designed to reduce healthcare costs by accelerating the use of IT to improve quality, safety and efficiency. Ultimately, patients and caregivers also will benefit from the automation and connectivity enabled by EHRs.

What is the potential financial benefit of the healthcare IT incentives to physicians?

Each office-based physician who meaningfully uses a certified EHR could receive up to $44,000 (Medicare) or $64,000 (Medicaid) in government funding. Office-based physicians practicing in rural or underserved areas would be eligible for up to $48,400 in Medicare incentives. It’s important to note that these figures represent the maximum allowable incentives under the Medicare and Medicaid programs, and that physicians may only qualify for either the Medicare or the Medicaid funding, but cannot qualify for both.

When will the payments be made?

Funds become available for office-based physicians on January 1, 2011 (and are eligible to apply through January 1, 2012 and still receive full benefits). Providers should begin planning as soon as possible to allow time to achieve meaningful use of certified solutions during this time period.

Are there additional incentives for office-based physicians to adopt in the early years of the
program?

Office-based physicians’ maximum allowable Medicare incentive for the first year of meaningful use is increased by $3,000, from $15,000 to $18,000, for meaningful EHR use in 2011 or 2012. This “early adopter” incentive raises the total amount physicians can qualify for from $41,000 to $44,000. A benefit for office-based physician early adoption does not exist under the Medicaid incentive program.

What is meant by “meaningful use” of healthcare IT?

Funding and incentives are tied to “meaningful” use. While no one yet knows the full definition of meaningful use, preliminary descriptions include the following:

An eligible professional shall be treated as a meaningful EHR user for a reporting period for a payment year if the following requirements are met:

• Meaningful use of certified EHR technology. The eligible professional demonstrates to the satisfaction of the HHS Secretary, that during such period the physician is using certified EHR technology in a meaningful manner. The certified EHR shall include the use of electronic prescribing as determined to be appropriate by the HHS Secretary.
• Information exchange. The eligible professional demonstrates to the satisfaction of the HHS Secretary that during such period such certified EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination.
• Reporting of measures using EHR. Using such certified EHR technology, the eligible professional submits information for such period, in a form and manner specified by the HHS Secretary, on such clinical quality measures and such other measures as selected by the HHS Secretary. The HHS Secretary shall seek to improve the use of EHRs and healthcare quality over time by requiring more stringent measures of meaningful use selected under this paragraph.

Will the incentives be applied to systems already in use, or will they be applied to the
purchase of new systems only?

The incentives are available to meaningful users of certified IT systems described in the legislation regardless of when they were implemented. The qualifier is the date at which the eligible provider can demonstrate meaningful use of the certified technology.

Access more physician funding questions and answers here.

A special session at this month’s HIMSS Conference advised physicians not to wait for HITEC funding to become available, but to go ahead and develop a gameplan for implementation to ensure that they qualify for incentive funding when final regulations regarding the funding are released.

Bruce Fried and Lauren Mack, with the law firm Sonnenschien, Nath & Rosenthal LLP, Chicago, offered the following tips for physicians:

“* Assess what gaps your organization has regarding satisfying the already defined requirements for a qualifying records system. For example, electronic prescribing and electronic order entry are mandatory.

“* When entering contracts with EHR vendors, require explicit language that they will meet any emerging requirements of federal certification for records systems.

“* Begin educating stakeholders outside the I.T. department who will be involved in facilitating adoption of electronic records.

“* Monitor the details of the regulations as they emerge.

“*In budgeting for EHR implementation, consider all costs, including software, hardware, training, help desk and maintenance.”

Read more here. Also, click here for more information about physician funding.

OMNI Medical Group Implements EHR Solution, Yields Positive ROI and Better Disease Management

When OMNI Medical Group and its parent hospital, St. John’s Health System, made the strategic decision to abandon paper charts and automate operations by implementing an integrated electronic health record (EHR) solution, the multispecialty physician practice sprang into action. OMNI saw this as an opportunity to further its mission to achieve medical excellence through evidence-based medicine. Management began a comprehensive search for the right EHR vendor, and then embarked on a phased implementation across OMNI’s multiple, geographically separated practices.

Once the EHR system was implemented, OMNI not only freed-up cash but also released from paper files patient medical information critical for analysis in the group’s disease management program. Now, OMNI’s clinical processes and operations are more cost-effective, saving full-time equivalent (FTE) costs and capturing lost revenue with increased coding accuracy. Additionally, the group’s quality of care is better. OMNI physicians use the EHR system to track and manage treatment for patients with chronic conditions.

Organization at a Glance: OMNI Medical Group, Tulsa, Okla.
– Subsidiary of St. John’s Health System
– 100-provider multispecialty practice
– 35 locations in northeastern Oklahoma

Solution Spotlight
– Practice Partner® Patient Records Critical Issues
– High operational costs
– Inefficient processes
– Inaccessible patient information

Results
– Eliminated more than $500,000 per year in transcription costs
– Increased annual revenue by $260,000 with accurate coding
– Saved $275,000 per year through the reduction of medical records staff
– Launched a disease management initiative that helped physicians increase the number of diabetic patients receiving an A1c test

Read the full case study: “OMNI Medical Group“