Part B Insider (Multispecialty) Coding Alert

Do a cost-benefit analysis and look into leasing

Electronic medical records can help you to document more effectively and improve your coding for office visits that deserve a higher level than you've been giving them.
 
With a good EMR, "I believe a good practitioner will probably see a boost in their reimbursement and be compliant at the same time," says Barbara Cobuzzi, president of Cashflow Solutions.

But not all EMR solutions are the same, and not all practices need an EMR. Consultant Robert Burleigh with Brandywine Healthcare Services in Malvern, PA offers a checklist of things to consider when evaluating an electronic medical record.

1. Cost per record. First of all, look at the absolute cost of the product, Burleigh advises. Then, look at how many records you'll use it for and the cost per patient record. Compare this with other EMRs, but also with the cost of a dictation service or paperwork.

2. Your docs' technical chops. Whether to get an EMR, and which one to get, depends on how technically proficient your physicians are, says Burleigh. Younger physicians tend to be more comfortable with computer-based systems.

3. Ease of training. How easy is it going to be to train your physicians to use it? Are there training courses available for this product?

4. Ease of use. How does the doctor create the record? Can you connect the EMR to the doctor's palm pilot? Can you set up templates for visits that happen frequently, such as well-woman exams?

5. Security. This includes both technical and physical security of the data, says Burleigh.

6. The provider. How long-lived is the company providing this product? Is it "somebody nobody's ever heard of before, or is it a fairly established company with a general product line behind it?" asks Burleigh.

7. Integration. If the product is a standalone, does it integrate with the products you're already using? Or can you get an EMR that's part of a suite of other products?

8. Ability to export. How easy is it to send copies of records to colleagues for consultations? "Am I able to create  print version or a fax version or some exportable version that is easy to work with?" asks Burleigh. "In some cases I may even want to know whether I can easily export it over to a hospital."
 
"I've known some situations where they've implemented an EMR and it's been nothing but a nightmare," says consultant Barb Pierce with Professional Management Midwest in Omaha. The implementation was more difficult than expected, and one system forced the physician to finish an encounter before the patient left for the day. That was a challenge because the physician didn't usually dictate records before the end of the day.

An EMR can cost $60,000 to $100,000 but it can pay for itself within a couple of years, says consultant John McDaniels with Physician Management Group in New Orleans. A small practice should perform a cost-benefit analysis to make sure it can afford this expensive solution. There may be ways to reduce the expenses, for example by purchasing a practice management system that already includes an EMR. You can work out a lease agreement with your provider that only costs you $2,000 extra per month instead of $100,000 up front.

Over time, as younger doctors enter the practice of medicine and older doctors retire, EMRs will become standard, says McDaniels. A large percentage of doctors over 50 don't want to  learn the new system, but younger docs love it. "It's difficult to implement unless everyone's on the same page," he adds. McDaniels predicts that 65 to 70 percent of practices will have EMRs in 10 years, up from 25 percent now.