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Impact of EHR adoption on patient volume, revenue not significant
Meaningful Use incentive payments did not offset capital and personnel costs related to EHR implementation, study finds.
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Implementation of an electronic health record system did not significantly increase revenue or patient volume in a large multispecialty ophthalmic practice, according to a study.
In addition, U.S. government incentive payments for EHR adoption did not offset the costs of implementation, Rishi P. Singh, MD, and colleagues at the Cole Eye Institute reported in JAMA Ophthalmology.
“I think [the study] validated that, at least in our experience, electronic medical record use didn’t decrease the patient flow, the volume, the revenue for our multi-specialty ophthalmology group. That’s probably one of the biggest takeaways,” Singh told Ocular Surgery News.
Singh said the study did not examine how EHR adoption affected quality of care, which is one of CMS’s key goals of EHR adoption.
“There is really no way to determine how quality of care will be transformed by this implementation. We know that we are seeing patients in the same amount of time and have similar clinical outcomes; however, we really need multiple years to determine what the true impact was,” Singh said.
Methods and measures
A customized version of the Kaleidoscope Ophthalmology Module (Epic) was implemented among all ophthalmic subspecialties at the Cole Eye Institute. Twenty-three practitioners participated in the EHR implementation: two comprehensive ophthalmologists, five cornea specialists, two glaucoma specialists, two neuro-ophthalmology specialists, one oncology specialist, one optometrist, two pediatric ophthalmologists, one oculoplastic specialist, six retina specialists and one uveitis specialist.
The system was fully implemented on April 2, 2012.
Singh and colleagues reviewed 13,969 patient encounters before EHR implementation and 14,191 encounters after implementation.
Main outcome measures were net revenue, patient volume, revenue-to-volume ratio, diagnostic and procedure volume, capital and implementation costs, EHR incentive payments received, and coding volumes, including eye codes and evaluation and management codes.
Volume and revenue
There were no significant changes in total net revenue, patient volume or revenue per visit between the pre-implementation period and post-implementation period.
“The revenue-to-volume ratio measurement allowed us to kind of measure each encounter and say, ‘Did we get more revenue per patient seen?’ The answer was that it wasn’t statistically significant between those groups,” Singh said.
Mean net revenue declined after implementation by $44,732 per month, but the difference was not statistically significant. Overall revenue per visit decreased by $7.
Monthly revenue increased $17,627 for oncology (P = .02) and $9,954 for plastic surgery (P = .009) after implementation.
Monthly revenue decreased $26,513 for comprehensive ophthalmology (P = .01), $27,972 for neuro-ophthalmology (P = .02) and $12,442 for pediatric ophthalmology (P = .02).
“It’s not across the board that we had universal efficiency. We had some practitioners who saw some declines in their overall revenue, probably owing to how these individual practices are impacted by EMR,” Singh said.
Overall patient volume increased by a mean of 217 visits per month from 2011 to 2013, but the increase was not significant. Volume increased by 198.5 visits per month for glaucoma specialists (P = .01).
Overall use of eye codes decreased by 15.7% and use of E/M codes increased by 14.7% after EHR implementation (both P < .001).
Costs and incentive payments
Capital costs totaled $1,571,864, and personnel and ongoing costs totaled $1,160,694.
Stage 1 Meaningful Use incentive payments from CMS totaled $18,000 in 2011, with one physician participating, according to the study.
“It’s not a given that we will be successful at meeting Meaningful Use for all of those stages. We are struggling, as others are, to meet those requirements. That’s in the best case scenario that we get our implementation costs back,” Singh said. “There’s still a divide between what the Meaningful Use payments are and what we end up spending. Our practice didn’t see a benefit or even an equivalent in those two costs. It was more like a loss, at least in the near term.”
It is projected that 23 of 25 physicians at Cole Eye Institute will participate in the Meaningful Use incentive program and receive stage 1 and stage 2 incentive payments for 2012 through 2016.
Cole Eye Institute expects to receive a cumulative total amount of $983,103 in Meaningful Use incentive payments by 2016. – by Matt Hasson
- Reference:
- Singh R, et al. JAMA Ophthalmol. 2015;doi:10.1001/jamaophthalmol.2015.0457.
- For more information:
- Rishi P. Singh, MD, can be reached at Cole Eye Institute, Cleveland Clinic, 9500 Euclid Ave., Room i32, Cleveland, OH 44195; email: drrishisingh@gmail.com.
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Laurie K. Brown, MBA, COMT, COE, OSA, OCS, CPSS
There is no question that EHRs are better records of patient care. Practices should not opt for EHR to realize financial gain, but instead to increase the quality of their work. Jobs change significantly with EHR for the better. Paper chart hunters and chasers can now be chart auditors. Charge entry staff can now scrub coding internally at a deeper level before submission. Physicians have access to patient records from anywhere and anytime. And a more complete and legible representation of the care visit is documented. No payer, Medicare or otherwise, will be covering the cost of computerizing a practices systems.
The carrot CMS is providing is just what it has named it, an incentive to take the leap. Having converted to electronic medical records almost 9 years ago, my practice would never revert back to paper. We undertook the project to reap the benefits of EHR and did so early to ensure we had the time to design a system that allowed us to move our already efficient patient visit process to an electronic format, before feeling forced into the future technology on someones timeline. We have realized a long list of workflow changes we continue to enjoy, which allow our staff members to work at a higher level, utilizing their training more completely, while enhancing patient care.
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