An EHR that delivers results
By LaShonza Alexis, February 2012
Arizona doctors credit EHR with helping them grow their practice into the largest of its specialty in the state.
Before implementing an electronic health record (EHR) and practice management (PM) system, Drs. Goodman & Partridge, OB/GYN was a seven-provider specialty practice. Today, the Chandler, Ariz.-based practice has 37 providers, including 26 physicians in seven offices, and is the largest OB/GYN practice in Arizona. In addition, it has boosted bottom-line revenue by more than 26 percent.
Perhaps even more astounding than its revenue growth, the practice also has been able to reduce expenses by more than $1.5 million a year while improving patient care and satisfaction. The practice credits much of this growth to an EHR system that has virtually eliminated paper from operations and provided invaluable, extra features, such as customizable templates, automated recalls and marketing ROI reports.
Much of the cost savings the practice has realized can be traced to a reduction in paper costs and transcription fees, but it also comes from greater efficiencies gained at each of the practice’s offices. For example, multiple providers can work in the same chart at once, all offices share the same chart information and real-time billing information is available for instant analysis.
Most importantly to the providers, the EHR system has helped Drs. Goodman & Partridge, OB/GYN deliver better patient care. The practice communicates more effectively with women about their pregnancies and personal health; it also helps patients stay involved in their health and adherent with their care plans.
Eliminating paper saves millions
Drs. Goodman & Partridge, OB/GYN went live with its EHR system on May 1, 2005. The most immediate and tangible financial benefit for the practice was eliminating paper from daily operations, as well as the labor involved in recording and sharing patient data on paper.
With seven providers at the time, the practice employed four full-time, in-house transcriptionists who were paid $31,200 each per year. Four “chart runners” each were paid $19,968 per year plus mileage reimbursement to drive charts between the practice’s various locations. (In order to best accommodate the practice’s OB/GYN patients, Drs. Goodman & Partridge encourages patients to visit whichever location is most convenient for each visit. Paper-based charts, therefore, had to be routed to the right location for each scheduled visit.)
The practice had long faxed prenatal information to local hospitals for unexpected and expected patient visits, but implementation of the EHR eliminated the need for chart transport between offices and hospitals. By sending prenatal records through its EHR system, the hospitals and on-call physicians can review any patient’s previous and current conditions.
The practice’s IT staff helped providers transition to the EHR by taking advantage of the system’s template editor. During training and rollout, physicians and other providers worked with electronic documents that were nearly identical to the paper forms they were used to. Furthermore, the system’s document builder allowed staff members to design files similar to those their transcriptionists created.
By initially customizing the forms and files to mimic the paper-based processes providers and staff were familiar with, the practice quickly gained crucial buy-in. Over time, the practice gradually has enhanced its templates to collect more relevant information at the point of care, but still using formats preferred by providers.
IT staff members have developed several customized templates for the practice to document procedures that require specialized equipment and specific documentation. For example, when the practice recently began offering urodynamic testing, the IT staff developed a custom template to record the procedure using the providers’ specific input, while integrating the new service with the template suite providers access daily.
Today, it would require 22 transcriptionists and 22 chart runners to support the 37 providers if the practice still used paper records. Factoring in inflation, switching to an EHR has saved the practice more than $1.4 million a year in salaries plus more than $86,000 annually for 215,280 reimbursed miles.
The paper costs alone are significant. Each provider schedules 25 appointments a day on average, or 925 appointments total daily for the practice. Before the EHR system, each appointment created at least six sheets of paper for the patient’s chart, which translates to 5,550 sheets a day and more than 1.5 million sheets a year. What’s more, the practice receives 30 requests a day for medical records and sends about 35 requests per day to other locations.
With the EHR, the practice has eliminated the need to fax 975 sheets per day, or 19,500 sheets a month, just for the clinical staff. The billing staff used much more paper. Combined, the annual paper expense savings equal about $62,272. Based on our current growth, the practice estimates an annual labor and paper cost savings of $2.9 million by 2013.
However, the benefits have extended to more than just expenses. Through a partnership with its IT vendor, the practice now runs reports in its PM system that were nearly impossible with paper records. It can instantly view which higher-reimbursement procedures have not been paid, for instance, or which health plans are not paying according to the fee schedule, or how long claims have been outstanding.
By following up on the claims shown in these reports, the practice has increased its revenue by 26 percent, decreased outstanding A/R by 76 days and overturned hundreds of denials. These claims account for millions of dollars the practice did not collect before adopting the NextGen Ambulatory EHR and NextGen Practice Management systems.
Automating functions ensures better patient care
On the patient-care side, the ability for multiple staff members to work in a patient’s chart is now a reality. The lab department can simultaneously input test results while the triage department can log a phone call and the billing team can access the record to find documentation for a claim appeal. It all adds up to much smoother operational, fiscal and patient-care processes.
One example is the system’s automated recall feature, which has been invaluable to the practice. This function helps patients follow their health/pregnancy-management plans by reminding clinical and front-office staff about follow-up appointments, treatments and testing.
After a visit, for instance, a provider’s note in the EHR to follow up with the patient in three months synchs with the PM system to be scheduled before checkout. Nearly three months later, the recall system will alert front-office staff members to remind the patient of the appointment. Soon, the practice will upgrade its telephone system so appointment reminders will be automatic.
Another feature that has improved patient care is the ability to upload ultrasound images into patients’ charts almost immediately after images are captured. After an ultrasound study is completed, the equipment burns the images onto a DVD, and that information is then uploaded into the patient’s EHR. (The EHR actually is capable of capturing images directly from the ultrasound device, which would eliminate the need for a DVD. However, the ultrasound manufacturer charges a significant fee to enable that feature, so the practice is still contemplating the upgrade.)
Regardless, an ultrasound and follow-up visit with a provider on the same day keeps the practice’s anxious obstetric patients and nervous gynecological patients from having to return for ultrasound results. This way, any immediate questions are answered and they can receive appropriate and complete follow up. Likewise, when obstetric patients visit the hospital, lab results and ultrasound images are immediately accessible electronically. The practice’s doctors can log in and access the patients’ charts as if they were in the office and see the most current test and medication data, which helps avoid delays, complications and potentially harmful duplicative testing.
New efficiencies, new patients, bright future
Prior to adopting its EHR, trying to quantify return on investment (ROI) was difficult at best. Like any growing practice, though, it was important to be able to track how new patients came to hear about Drs. Goodman & Partridge.
While operational and financial efficiencies are to be expected when automating a practice’s systems, the ability to report on marketing results was an unexpected, but welcome, addition. The system now allows the practice to collect data from patients, such as how they heard about the practice and what insurance they have, and track this data to determine the most efficient way to spend marketing dollars.
Here is an example: In May 2011, the practice determined most new patients arrived through PPO/HMO network directories and physician referrals. However, 153 new patients saw the office while driving by, 17 new patients came from billboard advertising, five from the Yellow Pages ads, two from the practice’s Adopt-a-Highway signs, two from magazine ads, one from a newspaper ad and 117 from the Internet.
Based on this type of reporting, aside from health plan networks and physician referrals, it is clear that the practice’s website and its search engine accessibility are crucial to its marketing efforts.
The practice also tracks when established patients recommend the practice to new patients. When they do, the established patient receives a reward, such as a gift certificate for a massage. This incentive program is also managed within our automated systems and helps encourage new patient visits while maintaining established patient awareness and satisfaction. Without the ability to track this data, however, it would be extremely difficult, if not impossible, to track marketing and patient incentive efforts with this kind of precision.
In fact, it is pretty safe to say that Drs. Goodman & Partridge, OB/GYN could not be the practice it is today without the capabilities of its EHR system. Eliminating the hassles of storing, handling and sharing paper has saved it millions of dollars, but the benefits extend to more than just digitization.
LaShonza Alexis is the billing supervisor at Drs. Goodman & Partridge, OB/GYN. For more on NextGen Healthcare, click here.