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Complying with the Meaningful Use Incentive to Optimize the Return on Investment from Your EHR

David N. Gans, MSHA, FACMPE Vice President Innovation and Research Medical Group Management Association July 30, 2011. Complying with the Meaningful Use Incentive to Optimize the Return on Investment from Your EHR Hawaii Health Information Exchange Health Information Technology Summit

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Complying with the Meaningful Use Incentive to Optimize the Return on Investment from Your EHR

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  1. David N. Gans, MSHA, FACMPE Vice President Innovation and Research Medical Group Management Association July 30, 2011 Complying with the Meaningful Use Incentive to Optimize the Return on Investment from Your EHR Hawaii Health Information Exchange Health Information Technology Summit Honolulu, Hawaii

  2. About MGMA Our mission…To continually improve the performance of medical group practice professionals and the organizations they represent MGMA has • 23,500 members… • Who manage and lead 13,700 organizations • With 280,000 physicians • Providing about 40% of U.S. physician services

  3. Learning Objectives • Describe the differences in financial performance between practices that use paper based medical records and practices that use EHRs • Describe the state of EHR implementation and how to optimize the benefit of using an EHR • Identify how to qualify for the HITECH incentive payments authorized by the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA)

  4. Part I Increased use of electronic health records by physicians

  5. The Federal Stimulus Has Incentivized Investment in Information Technology

  6. EHR Adoption Rates – 2005 MGMA / UMN Study MGMA Center for Research / University of Minnesota 2005 survey of medical groups Source: D. Gans, J. Kralewski, T. Hammons MD, and B. Dowd, “Medical groups’ adoption of electronic health records and information systems” Health Affairs, Sept./Oct. 2005

  7. EHR Adoption Rates – 2007 MGH Institute for Health Policy Study Electronic health record use and benefits Massachusetts General Hospital Institute for Health Policy 2007 Survey Source: C. DesRoches, et al. “Electronic Health Records in Ambulatory Care – A National Study of Physicians” New England Journal of Medicine, July 3, 2008

  8. EHR Adoption Rates – 2008 NAMCS SOURCE: CDC\NCHS, National Ambulatory Medical Care Survey, Electronic Medical Records Supplement, 2008

  9. EHR Adoption Rates – 2009 Medscape Study Medscape Business of Medicine, Electronic Medical Record Survey Results: Medscape Exclusive Readers' Choice: 10/06/2009

  10. EHR Adoption Rates – 2010 NAMCS SOURCE: Chun-Ju Hsiao, Ph.D.; Esther Hing, M.P.H.; Thomas C. Socey; and Bill Cai, M.A.Sci., Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates, CDC\NCHSDecember 2010

  11. Percentage of Office-Based Physicians with Electronic Health Records SOURCE: Chun-Ju Hsiao, Ph.D.; Esther Hing, M.P.H.; Thomas C. Socey; and Bill Cai, M.A.Sci., Electronic Medical Record/Electronic Health Record Systems of Office-based Physicians: United States, 2009 and Preliminary 2010 State Estimates, CDC\NCHS December 2010

  12. Defining the Difference in a Basic EHR System and a Fully Functional System

  13. Part II Differences in financial performance between practices that use paper based medical records and practices that use EHRs

  14. Recent Research Sheds Doubt on the Economic Benefit of EHRs.

  15. Economic Impact of Electronic Health Records • MGMA Cost Survey Report • Survey frame of MGMA Medical Practices • Conducted annually with similar questionnaire format and definitions since 1979 • Voluntary response by medical practice administrators • 2010 report based on data submitted by 1,955 medical practices, representing the financial performance of 34,992 FTE physicians • 2010 report included information from 560 practices with an electronic health record • Results summarized in the MGMA Electronic Health Record Impacts: Revenue, Costs, and Staffing Report: 2010 Report Based On 2009 Data

  16. EHRs Impact Staffing in Physician Owned Practices Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  17. EHRs Impact Staffing in Hospital Owned Practices Differently Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  18. Impact of EHR on Key Staff in Physician Owned Practices Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  19. Impact of EHR on Key Staff in Hospital Owned Practices Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  20. Impact of EHR on Physician Owned Practice Selected Expenses Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  21. Impact of EHR on Hospital Owned Practice Selected Expenses Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  22. Impact of EHR on Physician Owned Practice on Total Revenue, Expense, and Net Profit Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  23. Impact of EHR on Hospital Owned Practice on Total Revenue, Expense, and Net Profit Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  24. Impact of EHR on Physician Owned Practice Revenue and Expense Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  25. Impact of EHR on Hospital Owned Practice Revenue and Expense Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  26. Lessons Learned on the Three States of EHR Adoption • During implementation: Operating costs increase and productivity is reduced • Transition (6 to 24 months following implementation): Surprises and challenges continue to affect operating costs and productivity • Optimization (post transition): The benefits of EHR adoption generally exceed costs and most practices wondered how they ever conducted business without an EHR

  27. Impact of EHR Over Time on Physician Owned Practice Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  28. Impact of EHR Over Time on Hospital Owned Practice Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  29. Impact of EHR Over Time on Physician Owned Practice Selected Expenses Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  30. Impact of EHR Over Time on Hospital Owned Practice Selected Expenses Source: MGMA Cost Survey: 2010 Report Based on 2009 Data

  31. Financial Impact of EHR on Physician Practices • Allowing sufficient time for installation and change in processes, in general, practices with an EHR have: • Greater revenue • Increased expenses • More profit than practices with paper medical record. • The process is not linear and some practices achieve immediate return on investment, while others have increased costs and lower productivity years after implementation • The worst possible situation is the practice that maintains both paper and electronic health records, as it has none of the advantages of either a paper or electronic health record, but experiences the disadvantages of both systems.

  32. Implementing an EHR Causes Permanent Changes in a Practice • An EHR does more than just convert a paper medical record into electronic format for faster communication and recall, it fundamentally changes practice work, communications, and access to information. • Existing staff and physicians must be trained to use the system • New staff must be hired with different skills • An EHR requires different work flow than a paper record. • An EHR creates a database of information that can be mined as well as new tools that physicians and the practice can use to improve the quality of patient services •  An EHR presents new opportunities to improve patient care and creates new problems that can impact staff and patients.

  33. Testimonials on EHR Return on Investment • We are definitely receiving a ROI on our EHR but during the first year it cost us much more than it saved us. Physician productivity is actually higher but they used it to get out of the office earlier (quality of life) versus actually seeing more patients. • Expensive to start, but ROI should be under three years. It is the only way left to significantly impact practice expenses. • A robust EHR, carefully selected and painstakingly implemented can be a huge benefit. It’s ROI includes reduction in staff, increased billing, faster A/R, better documentation and patient safety and pay-for-performance initiatives.

  34. Part III Describe the state of EHR implementation and how to optimize the benefit of using an EHR

  35. Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data MGMA study that classifies medical practices according to their stage in the EHR implementation process and identifies the current needs and information needs at different stages of EHR implementation Online electronic questionnaire distributed by direct e-mail Data collected October 1 – November 9, 2010 4,588 medical organization responded Responses represented information for practices with160,000 physicians (25% of total U.S. physicians) Results are available as a free download at MGMA.com

  36. EHR Implementation Status Differs for Physician and Hospital Owned Practices Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  37. Just Because a Practice Has an EHR Does Not Mean that All Doctors Use the System Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  38. Practices Often Underallocate Training Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  39. Practices Without an EHR Perceive Significant Barriers to Implementation Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  40. Barriers to Implementation are Different for Smaller Practices than Larger Organizations Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  41. Integration of the EHR and PMS Is Critical But Not Universal Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  42. No Single Vender Dominates the Market Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  43. EHR and PMH Systems Integration Is Directly Related to Satisfaction Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  44. EHR and PMH Systems Integration Varies by Practice Ownership Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  45. Practices that Self Report Optimization Also Report Other Successes Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  46. Paying for the EHR Is a Problem Only for Practices with a Paper Medical Record Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  47. Capital and Two Year Operating Costs of an EHR Approximate the HITECH Incentive Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  48. EHR Payment Methods Vary by Owner Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  49. Practice’s Which Optimized EHR Operations Report Reduced Operating Cost Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

  50. Practice’s Which Optimized EHR Operations Report Increased Physician Productivity Electronic Health Records, Status, Needs and Lessons: 2011 Report Based on 2010 Data

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