Resource Centers:(News, information, and tools to support your practice)
September 2010
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The $44,000 question: industry insider responses (Neil Skene)
This is in reference to Melissa Heyboer’s article, “The $44,000 question,” which appeared in Issue 13, 2010. The following is Neil Skene's responses in their entirety.
Question 1: How will this affect the chiropractic office? i.e., do you think this program is beneficial?
A: First of all, we think the right EHR system will change a doctor’s life and practice dramatically, in good ways. A lot of first-generation EHR products were expensive and clunky. Having an old EHR is like having AOL dial-up internet, compared with new-generation products like MedAffinity. I’m not sure anybody loooved their first EMR system, not in the way people love their iPods or Kindles. Then, just as new-generation products were coming to market, the stimulus came along, with incentives for early adoption. It stimulated doctors to take a new look. And a few of the new products are very good. The stimulus makes it worth the time to find the right product. What you want is sophisticated functions in the background and ease of use for the doctor and staff.
With a little thought and reorganization, a good EHR system increases productivity. No question. Doctors save time, the staff saves time, paper costs are reduced. That means lower costs and new revenue opportunities. Better documentation of claims and bills improves collections and cash flow. And not incidentally, we think it also improves patient care. And an EHR supports the patients’ growing interest in access to their own health records.
Instead of just reducing staff costs, devote the time you save to seeing more patients. Devote some staff time to marketing activities like newsletters or mail, on additional patient services, or handling retail products for sale.
Question 2: What do chiropractor’s need to take advantage of this incentive? How much will it cost, as far as time and money, to implement?
A: The first thing chiropractors need to do is to talk to your staff. We had a prospect tell us he already had an EHR system, and we said, “Talk to your staff.” They hated the EHR system and wasted a lot of time with it. So he looked at what ours would do, and bought it. The staff can tell you their needs. Doctors don’t know everything.
And let the staff know that this is not about cutting staff. Tell them your goal is creating time for more important things, and making their jobs better. Ask about the things they get satisfaction from, and what frustrates them. Ask where you spend money or effort uselessly. Retrieving paper files. Space for paper files. Finding lost files. Juggling appointments. Writing patient notes on paper. Transcribing or reviewing transcriptions. You’ll start to see the possibilities, and you have started a wish list for your EHR search.
Coding is a challenge. If the EHR doesn’t help you link your activity to codes, look at something else. If the EHR doesn’t offer better claims support, look at something else. Get an EHR that lets you work the way you want to. If they have whole training
Don’t just think about yourself. It needs to support your staff. That’s why the selection needs to be a team consideration.
Consultants will tell you about project plans, and those are important. You need to ask not just the cost of the product but the cost of installing it and customizing it and using it. Leading computer manufacturers refer to the “out of the box experience,” what a customer experiences in setting up a new desktop or laptop. What’s the out of the box experience for your EHR?
What are companies charging for installation and onsite training? Our system arrives in a pre-loaded server, you plug in the power and the office network, and we take it from there. We’ll email you a probably to click and install a little program on each computer desktop. And then you get everybody together for a two-hour live online training we conduct. You can practice, come back in a day or two for another round, which is mostly review and questions, and you’ll be running. It may be a little more complicated if you need custom links to your billing system, or some other special need. But installing and EHR should not require and MBA and a degree in rocket science. You don’t have time, or money, or patience for that.
Ask the provider to tell you every step of the installation and whether it costs extra, and ask them to promise to give you your money back if there are any surprises. That’s what I’d do.
You need to decide how much of your old files you want to convert to the new system, and how you’ll do that. Unless you are moving or expanding and really need to get rid of old files, most offices don’t need to convert everything. As long as you have a good history, you don’t need all those documents from 10 years ago. Do “just in time” conversions. Part of the set-up for each day is getting recent paper documents scanned in to the EHR for ready retrieval. Don’t waste money digitizing what you don’t need anymore. Put it in storage.
You need to know about data backups, which should be offsite and totally invisible to you and your staff. You need to know how the EHR meshes with scheduling and billing. You really want to know about the claims documentation. And you want to have a checklist of the requirements for the stimulus reimbursement and what you have to do to apply for it successfully. You want to know about ease of financing, if that’s important.
But you don’t have try to claim all the efficiencies at once. Professional organizations and publications like this one will have a lot of ideas on how to maximize the benefits.
Question 3: Will all chiropractic offices qualify? Can cash-based practices benefit?
A: I have seen nothing limiting this to accrual-based accounting. Obviously, you have to be a Medicare provider to the get the reimbursement. But there are limitations on chiropractors’ services that will qualify.
Question 4: When can chiropractors expect to receive payments?
A: Final decisions at the federal level are something of a moving target, but it appears to us that early adopters who are meaningfully using a qualified EHR system by the end of 2010 could receive the first reimbursement as early as spring 2011. All that is required initially is 90 days of meaningful use. This period of use will be toughened later on. The real uncertainty for 2011 comes from the certification process, which is still being developed.
Question 5: What questions should chiropractors ask their providers (insurance and software) to ensure they are being compliant?
A: Did not answer.
Question 6: What new products or services do you think will come out of this incentive?
A: Did not answer.
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