Track 1: EHR Implementation and Adoption September 9, 2008 AHRQ Annual Conference 2008

Copyright 2008. Medical Group Management Association. All rights reserved.

Track 1: EHR Implementation and Adoption

September 9, 2008

AHRQ Annual Conference 2008Bethesda, MD

David N. Gans, MSHA, FACMPEVice President Practice Management Resources

Medical Group Management Association

Impact of Electronic Health Records on the Financial Performance of Medical Group Practices

Copyright 2008. Medical Group Management Association. All rights reserved.2

Impact of EHR on Medical Practice

“One accurate measurement is worth a thousand expert opinions.”

Rear Admiral Grace Hopper


Learning Objectives

Understand how Electronic Health Records affect the economic performance of medical group practices:

• in the perception of medical practice administrators who describe how electronic health records impacted their practices

• by cross sectional comparison of medical groups with and without electronic health records

• by longitudinal assessment of practices that implemented an electronic health record in the past two years

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Name, credentialsOrganizationDate 4

Perception of medical practice administrators who describe how electronic health records impacted

their practices


MGMA 2007 Electronic Health Record Survey

• Survey frame of medical practices that responded to a 2005 national information technology survey

• Voluntary response by medical practice administrators• 570 practices responded describing their health record

system, including 285 practices that had an electronic health record


Summary of Study Findings

1. The study identified 285 practices where EHR implementation is in process or is fully implemented.

2. Respondents described increased operating costs, reduced productivity, and other surprises and challenges during the first 6 to 24 months of the implementation

3. After the first 6 to 24 months, the benefits of EHR adoption exceeded costs and most practices wondered how they ever conducted business without an EHR


Types of EHR

What is the name of your current EHR software product?Allscripts

Healthmatics7.27%

eClinicalWorks3.27%

EpicCare3.64%

GE Centricity11.64%

Greenway2.91%

Misys EMR11.27%NextGen

10.18%Practice Partner

2.55%

Sage Intergy3.64%

Other38.55%

Allscripts TouchWorks

5.09%


Perceived Impact of EHR on Practice Costs

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Allowing Six Months after Implementation For Physicians and Staff to Become Familiar with the EHR, What Then Happened to Practice Costs (Overall,

Including all Staff Expenses, EHR costs, Transcription Costs, etc.)?

Decreased, 40.4%

Stayed the same, 29.6%

Increased, 12.8%Do not know, 17.2%


Perceived Impact of EHR on Practice Productivity

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Allowing Six Months after Implementation For Physicians and Staff to Become Familiar with the EHR, What then Happened to Physician Productivity?

Stayed the same, 47.0%

Decreased, 8.5%

Do not know, 16.2%

Increased, 28.3%


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.


Name, credentialsOrganizationDate

Cross sectional comparison of medical groups with and without electronic health records

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MGMA Cost Survey Report

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• 2008 report based on data submitted by 1695 medical

practices, representing the financial performance of 29,215 FTE physicians

• 2008 report included information from 544 practices with an electronic health record


Cross Sectional Analysis

• Identify medical groups with an EHR and practices with a paper medical record

• Categorize practices by specialty and ownership• Determine the mean for key revenue and expense

measures• Use the T-test to measure significance


Impact of EHR on Multispecialty Groups

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Hospital and Physician Owned Multispecialty Groups Paper

Medical records /

charts

Electronic health record system

Sig. (2-tailed)

Mean total medical revenue per FTE physician 675,608$ 752,142$ 0.03 Mean total support staff cost per FTE physician 205,040$ 228,808$ 0.04 Mean information technology equipment cost per FTE physician 9,963$ 15,024$ 0.00 Mean professional liability insurance cost per FTE physician 15,254$ 15,598$ 0.79 Mean total operating cost per FTE physician 430,459$ 469,521$ 0.12 Mean total medical revenue after operating cost per FTE physician 260,153$ 302,465$ 0.01 N = 118 134


Impact of EHR on Physician-Owned Multispecialty Groups with Primary Care Only

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Physician Owned, Multispecialty Groups with Primary Care Only Paper

Medical records /

charts


Sig. (2-tailed)



Impact of EHR on Family Practice

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Physician Owned, Family Medicine Single Specialty Groups Paper

Medical records /

charts


Sig. (2-tailed)



Impact of EHR on Cardiology Groups

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Physician Owned, Cardiology Single Specialty Groups Paper

Medical records /

charts


Sig. (2-tailed)

Mean total medical revenue per FTE physician 1,211,963$ 1,159,985$ 0.60 Mean total support staff cost per FTE physician 302,433$ 308,307$ 0.82 Mean information technology equipment cost per FTE physician 14,423$ 16,974$ 0.23 Mean professional liability insurance cost per FTE physician 19,930$ 22,752$ 0.32 Mean total operating cost per FTE physician 619,528$ 577,232$ 0.40 Mean total medical revenue after operating cost per FTE physician 607,515$ 582,752$ 0.67 N = 25 28


Impact of EHR on Orthopedic Surgery Groups

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Physician Owned, Orthopedic Surgery Single Specialty Groups Paper

Medical records /

charts


Sig. (2-tailed)

Mean total medical revenue per FTE physician 1,129,408$ 1,319,229$ 0.02 Mean total support staff cost per FTE physician 245,032$ 337,183$ 0.00 Mean information technology equipment cost per FTE physician 16,652$ 21,951$ 0.05 Mean professional liability insurance cost per FTE physician 37,441$ 32,997$ 0.31 Mean total operating cost per FTE physician 522,072$ 634,352$ 0.02 Mean total medical revenue after operating cost per FTE physician 608,699$ 684,877$ 0.17 N = 40 22



Longitudinal assessment of practices that implemented an electronic health record in the past two years

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Longitudinal Analysis

• Identify family medicine and multispecialty with primary care groups that indicated the practice installed an EHR in 2006 and reported information for the 2007 Cost Survey

• Identify if practice also participated in the 2005 Cost Survey

• Determine the change in revenue and expense for each practice

• To control for environmental change, perform the same calculation for family medicine and multispecialty with primary care groups that indicated the practice had a paper medical record.


Mean Two Year Change in Financial Performance for Primary Care Practice Mean Two Year Change in Financial Performance for Primary Care Practices that Installed an EHR in 2006, Compared to Similar Practices with a Paper Medical Record

Paper Medical Records/Charts


Total medical revenue per FTE physician $38,852 $ 53,010

Total support staff cost per FTE physician $15,060 $ 6,779

Information technology equipment cost per FTE physician $ (338) $ 1,816

Professional liability insurance cost per FTE physician $ (753) $ (1,523)

Total operating cost per FTE physician $ 29,543 $ 34,521

Total medical revenue after operating cost per FTE physician $ 6,603 $18,410

N= 24 9



Observations

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Observations

Allowing for sufficient time for installation and change in processes, practices with an EHR appear to have:

• Greater revenue• Increased expenses• More profitThan practices with paper medical record

The difference may be significant, but more study is needed.

Copyright 2008. Medical Group Management Association. All rights reserved.mgma.com

David N. Gans, MSHA, FACMPEVice President, Practice Management ResourcesMedical Group Management [email protected]

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Questions?

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Documents

Track 1: EHR Implementation and Adoption September 9, 2008 AHRQ Annual Conference 2008