Dos, don’ts, and dollars: Making the switch to an EHR

More and more ObGyns are adopting electronic health records (EHRs), not only to meet a government mandate but also with the hope of making their practice more efficient and productive. While it is likely that EHRs enhance qualitative benefits, such as safety, patient satisfaction, 24/7 availability of medical records, and patient access to medical data, it isn’t always clear how they boost the financial bottom line. For this reason, we recommend that every practice “run the numbers” before making the transition from paper to paperless records. That means estimating the cost, expenses, and potential for added income associated with the EHR before embarking on the change.

In this article, we explain five ways a switch to EHRs can reduce costs. We also offer strategies for choosing and implementing an EHR, from information gathering to motivating your staff.

Transcription costs are lower
The estimated cost of dictating a letter to a referring physician using conventional means is $12 to $15. That estimate includes the doctor’s time, the cost of the transcriptionist, the stationery, and the postage or cost of faxing the letter. An ObGyn may generate five to 10 letters per day. That’s $60 to $150 in expenses.

Most EHRs can generate a referral letter at no additional cost, provided the diagnosis, prescribed medications, and treatment plan have been entered in the system. Not only that, but each referral letter can be transmitted immediately to the recipient by email (or fax; the referring doctor’s preference). In the past, it may have taken as long as several weeks for the letter to be generated and make its way to the recipient by conventional means.

This use of the EHR can save a practice as much as $1,000 per physician every month.

Chart maintenance is no longer an issue
It sometimes can be a challenge for an ObGyn office to locate a paper chart. Any record lost in the “black hole” can wreak havoc with the schedule. It becomes even more problematic if the practice has multiple locations where charts are kept, delaying its recovery.

When a temporary chart must be created, it costs the practice time and dollars. It also becomes necessary to transfer the data into the permanent record, once it is located—another expense—not to mention the need to create a chart for every new patient.

It is not unusual for a busy practice to misplace as many as five charts a day, representing expenses of $25 to $50 per chart. With an EHR, this expense is reduced to $0, and the chart can be accessed 24/7 from multiple locations, including the physician’s home or mobile phone, provided the EHR is networked between practices and the data are secured on the cloud (with encryption to ensure patient confidentiality and compliance with the Health Insurance Portability and Accountability Act, or HIPAA).

Another expense with paper records: pulling charts for the day’s patients and returning them to the file rack at the conclusion of the day. These steps require additional employees and do nothing to improve patient care.

Coding is more accurate with an EHR
Prior to the development of EHRs, physicians had to guess the level of care that was provided and tended to “under-code” the visit, leading to a loss of income that the physician rightfully earned but didn’t document fully. As one coding expert has noted, if you didn’t document it, you didn’t do it, and if the record reflects that you didn’t do it, you can’t be paid for it.

In general, the higher the level of care and the higher the code used, the more extensive documentation should be. Today’s EHRs can automatically calculate the code best supported by the documentation entered at the time of the visit. After implementing an EHR, an ObGyn can ensure that accurate codes are submitted to payers, with higher levels of reimbursement honestly and ethically achieved.

A shift to EHRs frees up valuable square footage
It is not unusual for a practice to consume several hundred square feet of space for the storage of conventional medical records. Once a practice transitions to electronic records, however, these files are stored at a ­remote site or shredded once the entire paper record has been scanned into the EHR. The office space once required for paper record storage can then be converted into examination rooms or devoted to a laboratory, imaging center, or procedure room to generate ancillary income.

There’s an incentive involved
On February 17, 2009, the US government passed the Health Information Technology for Economic and Clinical Health (HITECH) Act in an effort to reduce the barriers to EHR implementation by outlining programs for standardization and funding of EHR programs.^1,2 The HITECH Act contained meaningful-use incentives to reward participants for the adoption of EHRs, with payments disbursed through Medicare and Medicaid.² By meeting several core objectives, individuals in private practice can earn as much as $44,000 over 5 years through the Medicare EHR incentive program and $63,750 over 6 years by participating in the Medicaid incentive program.³ Hospitals can earn more than $2 million over the same period. The objectives differ slightly for hospitals and individuals but are intended to improve quality, coordination, and safety of care while promoting patient involvement and public health.³