SOUTH AUSTIN MEDICAL CLINIC
South Austin Medical Clinic (SAMC) is a nine physician family medicine practice located in Austin, Texas. The practice provides comprehensive care with lab, radiology and acute care hours on evenings and weekends. Despite a long and successful history (the practice was first started in 1965), SAMC found itself struggling with the inefficiencies of the paper chart and a challenging reimbursement environment.
SAMC’s Dr. Eric Weidmann recalls, “Loose-leaf paper charts were time consuming to manage and difficult to keep organized, and they take up a tremendous amount of space. In our case we had a room the size of a two car garage just to store the charts.” Also, as payors shifted away from capitation to discounted fee-for-service, accurate visit documentation was becoming more important. “We found ourselves under coding and under billing services rendered because our visit documentation was not optimized,” Dr. Weidmann noted. “This became a real source of pain for our practice, particularly as reimbursement declined.”
Responding to the economic realities of discounted fee for service contracts and the desire to improve documentation organization, SAMC decided to make the switch to electronic medical records.
Physician participation was critical to getting the project moving. Two physicians within the group took the lead, helping prepare the cost/ benefit analysis and initiating the dialogue within the group to establish a budget and timeframe. The same two physicians split up leadership on hardware and software teams to establish basic requirements. All physicians were requested to take active responsibilities related to workspace design, workflow modifications, staff changes and the minor remodeling of the clinic for computer workstations.
The office manager and other key staff were invited to join as active participants in the process. SAMC completed a thorough technology and marketplace review and narrowed the list to two vendors. After a series of demonstrations and extensive internal discussions, eMDs was selected as the vendor of choice. Looking back Weidmann noted, “We felt like eMDs gave us the best of both worlds—a fully featured integrated system at a reasonable price.”
MAKING IT REAL
SAMC was careful to deploy the system in a manner that minimized disruption to their practice, selecting a 6 month “phase in” to full EHR implementation. Since they were deploying eMDs practice management system, they also needed a process for transitioning administrative and billing data from their old system. Working with eMDs project managers they developed and executed a smooth and successful implementation plan.
True to their “phase-in” approach, the two lead physicians made the initial leap, thinning their schedule by 25% for the first two weeks to gain familiarity with system and refine patient and office workflow. “This was very helpful in establishing a baseline process for EHR use,” noted Dr. Weidmann. “It made it much easier to bring on the remaining providers.” Within 4 months all the providers and staff had embraced the EHR—with the exception of one physician, who found the change challenging. SAMC got creative and established a customized approach for this individual—starting with simple entry of diagnoses, coding, and billing information and progressing to prescription writing and progress notes. The approach worked: the provider has now fully embraced the EHR. “While it is important to have firm deadlines for EHR use, it is also important to be flexible in working with individual physicians,” said Dr. Weidmann. “Fortunately for us, the eMDs EHR does a great job of accommodating different providers.”
THE PROJECT SUCCEEDS
The project has been a success. A fax server, three laboratory interfaces and eMDs Patient Portal allow the practice to receive most information electronically; incoming paper is scanned and included in the chart. Key information from their 60,000 paper charts have been transitioned to the EHR, virtually eliminating the need for chart pulls. “Even though patients and third parties still ask for paper documents, we have made the transition to a “paperless” office—which makes us very efficient” says Dr. Weidmann.
Moving to the fully integrated eMDs system has paid off. “All patient functions, notes, results, prescriptions, drug interaction alerts, scheduling, billing, and demographics are now easy to access and well organized. It functions beautifully.”
Integration has had a strong impact on billing and collections. Since deploying the system, average per visit reimbursement more than doubled, despite declining fee schedules on discounted fee for service contracts. With electronic charge capture at the point of care, combined with integration to a claims clearinghouse, collection days—the time from date of service to receipt of funds— were reduced by more than 70%, from 72 to 20 days. Additionally, with better charge capture, SAMC was able to significantly reduce lost charges.
“Pre-EHR, we estimated that we neglected to charge for about 32% of x-rays and vaccines. With the EHR that rarely occurs.” The positive financial impact of the system allowed them to recover their initial hardware and software investment in 26 months and increase provider revenue despite an 8% to 12% reduction of HMO/PPO reimbursement.
With the paper charts gone, SAMC was able to reclaim and remodel their chartroom for clinical functions, allowing the practice to double the number of providers and patient encounters within the same clinic space and reducing the per provider rent overhead by 50%. Improved processes have made their staff more productive. As an example, two experienced insurance specialists handle the entire filing and reconciliation of EOB’s for 9 full time providers with spare time to help with the phones. With greater efficiencies and higher reimbursement, SAMC was able to allocate more resources to the practice to foster retention and improve customer service and patient care.
Dr. Weidmann concludes, “eMDs has allowed us to help transform our practice in a way that is not only appealing to patients, employees and providers, but allows SAMC to effectively compete in a challenging and changing healthcare environment.”