Avoid the pitfalls of selecting the wrong EMR just because it is “certified”
Our best advice: Make sure that everyday use is first and foremost when selecting an EHR system that will be used under Meaningful Use. As we have studied Urgent Care practices over the past three years, we find that they are primarily for-profit businesses. Therefore, as a business we advise our clients to pay attention to the profitable operation of the business first, and then make decisions to enhance their practice by keeping revenues and expenses in mind. What we have observed is that the financial incentives and rewards around certification and Meaningful Use have clouded good business judgment.
For example, we have talked with many practitioners that have adopted “certified” systems that are capable of demonstrating Meaningful Use, but a significant percentage of them tell us that the systems are very difficult to use. One doctor told me that each patient visit takes an average of 30 minutes longer to complete because of the complexities of the system, the learning curve involved and the ongoing conversion from prior record-keeping methods. His goal is to collect the maximum $44,000 over 5 years from the government and avoid a 1% to 2% Medicare/Medicaid reimbursement penalty after that. But, if you do the math, you will see how the reimbursement-driven goals are clouding good business judgment.
Let’s say that an urgent care practitioner adopts a new system and it requires an extra 15 minutes per patient. If you see 12 patients per day under your old system, at 30 minutes per patient, that is effectively 6 billable hours per day. At an average of $100 per patient in medical reimbursements, you collect $1200 per day. Assuming that you are open 300 days per year, your annual gross revenues equal $360,000 per year. Now, let’s assume that each patient requires an additional 15 minutes because of the adoption of a new medical software solution. Instead of seeing 12 patients per day, you can now only see 9 patients per day for the same 6 billable hours. Your gross revenue now drops to $900 per day or $270,000 per year. You have now lost $90,000 in gross revenue in the course of a year in order to meet federal reimbursement standards that may provide a maximum of $18,000 in return…an amount that is actually federally capped and declining each year.
Remember: According to HHS, the amount eligible for Medicare reimbursement is calculated as 75% of your total Medicare billings…not based on your total practice billings. As a result, if your practice’s Medicare billings only represent 5% of your total revenue, the amount eligible for reimbursement is based on 75% of the 5%. This is a scenario we come across all the time and in this situation the provider will likely receive the maximum benefit!
On top of the lost incremental revenue outlined above, add to that what you’ve paid and will likely continue to pay, to buy, adopt and maintain your new system, including hardware and infrastructure costs, and it becomes clear that a systems decision should not be made in the name of a relatively minor 5-year federal reimbursement or the prospect of slightly reduced Medicare reimbursements.
What you want is a system that improves productivity and is easy to implement because there are multiple benefits to adopting technology. In our experience the real benefits to adopting a technology solution to medical charting should include the following:
- Improved record keeping and records retrieval
- Improved access to patient history
- Remote access from home or vacation allows you to track patient traffic and productivity
- Secure backup of medical records from fire, theft or other disaster
- Improved legibility and accuracy
- Accurate insurance and related demographic information by patient
There are countless other benefits from adopting an electronic patient charting solution that we see for an urgent care center, including speed with which you can process and complete patient visits. In fact, the math works both ways. If you adopt a system that not only preserves your current revenue stream, but actually allows you to see three more patients per day because of ease of adoption, improved efficiency or elimination of redundant efforts, then you have generated $90,000 in extra revenue each year, not $90,000 less.
Because of the significance of these financial results, your primary focus should be on adopting systems that improve the “pace of play”, not diminish it. Then, if you happen to buy a system that also meets the “certification” standards and enables the demonstration of Meaningful Use, you have added icing to the cake. If it is not obvious, the icing is not the cake. A well managed, profitable urgent care practice needs to focus on the cake.