Reaping the Benefits of a Digital Office: From EMR to Practice Management

Robert Hendler, Administrator Cardiac Specialists Fairfield, Connecticut
Robert Hendler, Administrator Cardiac Specialists Fairfield, Connecticut
Cardiac Specialists is a high-performance, high-volume practice specializing in cardiovascular health. In 2003, Cardiac Specialists was a two-location, ten-physician group practice searching for an electronic medical record (EMR) system that would allow its doctors to continue conducting exams as they were accustomed to doing, and one that would increase rather than decrease their productivity. Since that time, the practice has achieved tremendous growth, expanding to five locations and 15 physicians — growth that was supported by the implementation of the SRS Hybrid EMR (SRSsoft, Montvale, NJ) and CareTracker PM system. To date, with SRS the practice has achieved significant overhead reductions and revenue gains totaling $2.5 million, with relatively small incremental costs of approximately $250,000 for software and hardware over the 7-year period. As they experienced these gains in productivity, the leadership at Cardiac Specialists realized that its practice management (PM) system was outdated and was limiting its organizational effectiveness. They began searching for a practice management system that would allow greater control over the revenue cycle and eliminate the task of training staff in five separate offices on the millions of payer rules. With these goals in mind, the practice implemented the CareTracker PM system, and found that it was easy to use, streamlined the billing process, and capitalized on the efficiencies already realized by the EMR. Before going live with the SRS hybrid EMR, our practice endured the usual struggle to access medical records where and when they were needed across the five-location practice, and we were struggling to increase productivity. The inefficient office processes were symptoms of the practice’s aging infrastructure. Ease-of-use was a key factor in Cardiac Specialists’ purchasing decision because several colleagues had purchased expensive, complicated EMR systems that were ultimately too time-consuming to learn or use effectively. We were also aware of the high failure rate associated with traditional EMRs, and were hesitant to take that risk. However, after implementing the SRS hybrid EMR, significant cost savings were realized immediately. We reduced our medical records staff by 5 FTEs within the first three years, which represented a savings of approximately $850,000 over the last seven years. Despite having experienced tremendous practice growth since implementing SRS — expanding from 10 to 15 cardiologists and experiencing an even greater increase in patient volume — the practice did not have to hire additional billing staff, and added two fewer medical assistants than would have been necessary without SRS. In the last four years, this saved us another $520,000 in staffing costs. Eliminating the need for chart supplies generates an additional $3,000 per year in savings. All of these savings will continue to accrue in the future. The positive impact on our physicians’ time and productivity was immediate. In addition to being able to more efficiently review patient charts with SRS, our physicians are now able to stay current with their messages from home, the hospital, or the office. They access charts immediately from anywhere with an Internet connection, so callbacks to patients and referring physicians are quick and accurate — with full documentation archived and readily available. Some physicians have reduced after-hours time at the office because SRS enables them to respond to patient issues during hospital downtime or from home. Callbacks are now generally made on the same day (usually within two hours), not one or two days later. This is a key benefit that we believe directly improves patient care. In addition, this flexibility allows our physicians to make more productive use of their time in the office, freeing them to see more patients. We conservatively estimate that each of our physicians cares for one or two additional patients daily during office hours, which has increased our practice-wide revenue by over $1 million over the last seven years. Our physicians also save time by using SRS to ePrescribe, which will generate more than $100,000 annually in additional Medicare bonuses. They generate new prescriptions and refills efficiently, and the system automatically records the information in the patient’s chart. Recently, several of our physicians began using Dragon voice recognition software (Nuance Communications, Burlington, MA) to facilitate documentation of visits. Dragon integrates easily with SRS, and our physicians are embracing the software because it is easy to learn and use. This newfound capability is already significantly reducing our transcription costs. The SRS hybrid EMR has tremendously improved our efficiency practice-wide and enables us to be more responsive to our patients. We use the Message Pooling capability to distribute the workload among our staff and make maximum use of their time. We have trained several of our technicians to process physician messages regarding patient issues to minimize staff downtime, which makes their daily routine and workflow run more efficiently. This is especially necessary in today’s challenging economy where businesses are striving for creative approaches to working smarter. We continue finding innovative ways to benefit from our SRS hybrid EMR. One example we are developing is data mining, where data from our practice management system identifies patients who are overdue for visits and then allows our physicians to easily review their charts in the EMR to determine if they need to be scheduled for an appointment. This will not only give us the opportunity to establish stronger continuity of patient care, but it will also fill in our schedule with additional visits and generate increased revenue. We also recently opened a new office, which was accomplished uneventfully and at lower costs than we would have incurred had we had to move patient charts. Our physicians were ready to see patients the first day. All of these benefits are the result of having a digital office affording universal access to complete and accurate patient charts. Our cardiologists receive many routine patient calls daily with a variety of questions regarding medications, symptoms, and treatments. One of the most valuable aspects of installing the SRS hybrid EMR has been its capability to link the patient’s chart to messages that are sent directly to the appropriate physician’s inbox in real time. With 24/7/365 access to our patient charts, our physicians are providing better care and doing so faster, more accurately, and with greater ease at lower cost. With a moderate investment in the SRS hybrid EMR, we solved our medical records challenges and, more importantly, our physicians appreciated the ease of implementation and minimal training required. It was a sound, fiscally prudent decision that easily paid for itself over a short time frame. Most importantly, since we’ve adopted SRS, our physicians are more productive, the practice operates more efficiently, and we see more patients, providing them even better service than before. Practice Management: The Next Step It became clear that in order to maximize the financial and productivity gains realized from using the hybrid EMR, we needed to replace our outdated practice management system with one that would allow greater flexibility and control over our revenue cycle. We began implementation of the Ingenix CareTracker PM system (Ingenix, Eden Prairie, MN) approximately two years ago. After due diligence, we found CareTracker PM to be the best possible solution for our needs. A dashboard format provides instant, up-to-date performance information, enabling our management team to obtain an immediate snapshot of how the practice is functioning. Physicians benefit from instantaneous access to practice data from any computer. Because the system is Web-based, our IT and billing staff no longer need to get involved in modifications to the software, and the payer rules are now updated seamlessly in real time. The system includes a centralized list of referring physicians, payers, and plans that is automatically updated as changes occur. This list eliminated our messy “do-not-use” codes and duplicate entries. CareTracker PM also satisfied our desire for a system that the staff could easily master. The training process was comfortably short and included both live and recorded sessions. New staff members who have joined our practice since the introduction of CareTracker PM have quickly learned the system. Our practice immediately benefited from using this system. After implementation, we experienced a shortened revenue cycle: our days in Accounts Receivable (A/R) decreased to 25 — well below the Medical Group Management Association (MGMA) benchmark. Our practice now has almost no claims remaining in A/R beyond 30 and 60 days. Physicians and staff members enter charges electronically through visit-capture screens customized specifically for our practice, and following submission, the practice management system engages in automated claims scrubbing that produces cleaner claims transactions. The system then automatically checks on each claim’s status to catch potential denials. Since the implementation of the practice management system, our revenue cycle is much improved — and with fewer billing resources. Additionally, patient eligibility is checked automatically, starting up to five days before an appointment, so our staff only has to attend to the few patients who are flagged with an insurance eligibility issue. We often have patients who book appointments six months in advance and whose insurance changes during this time period; when this happens, CareTracker PM alerts our staff prior to the appointment that there is an eligibility issue. We also no longer have to manage the potential difficulties that ensued when a patient arrived with a new insurance plan that required a referral or pre-approval for the scheduled procedure. Eligibility checking, claims scrubbing, and claims status checking result in more than 90 percent of claims being paid at first pass, and there are fewer denied claims overall. When a claim doesn’t get paid the first time around, resubmitting the claim entails extra staff time, and the probability of getting paid is reduced. However, CareTracker PM allows us to get it right the first time, which is key for effective billing and reimbursement. We have also gained increased control of our practice’s finances through the use of CareTracker PM’s reporting capabilities. We use both default and easily generated custom reports to analyze revenue and trends by location, time period, and provider. Additionally, the system allows our practice to schedule and automatically run sets of reports. Summary By implementing the CareTracker PM system, we have built upon the productivity gains that we had achieved with the SRS hybrid EMR. Today, the PM and EMR both occupy a central role in our practice. Our physicians have become very accustomed to using the SRS hybrid EMR and the CareTracker PM system, and have completely incorporated the technology into their daily workflow.