Improve Patient Health – and Your Bottom Line – with Electronic Health Records By Robert Cowherd, MD
Director
Cowherd Family Medical Center
Seldom has the daily practice of medicine been more challenging for physicians. Changes in healthcare and an accelerating drive to control costs have put particular pressure on the business side of the small practice. Even as the costs of operating an office are soaring, reimbursement levels are declining. Practices with large numbers of Medicare patients – such as my own – have faced reduced fees and even delays in reimbursement that can threaten a physician’s financial stability.
In order for us to survive, physicians must adapt to new payment models that move away from fee for service and toward value-based reimbursement – better health, better care and lower costs. For practices making the transition to electronic health records (EHR), there is a wide range of opportunities for providing more efficient and better healthcare to patients, helping the practice qualify for increased reimbursement.
Data Drives Superior Patient Care
Located in a retirement community amid the scenic Ozark Mountains, Cowherd Family Medical Center relies on our McKesson EHR to electronically document patient labs, progress notes, diagnoses and managed care milestones. The EHR has changed our workflow and created positive improvements in patient health.
I can sit down at my computer and quickly generate a list of patients who need a particular screening test. Also, when a patient checks in for an office visit, the EHR immediately flags any tests and screenings that are needed. By incorporating standing orders into the system’s health maintenance templates, the nurse can schedule an EKG, chest X-ray or prostate-specific antigen (PSA) test even before I see the patient.
We joined the Practice Partner Research Network (PPRNet), a practice-based research network, to more efficiently care for our patients and monitor their health outcomes. Our practice uploads secure patient data collected by the EHR to PPRNet, where the information is translated into easy-to-read graphs and charts. These reports enable us to treat patients proactively and track trends against industry benchmarks for chronic diseases. The reports also trigger maintenance checks that comprise the heart of our preventive care plans and provide a focus for staff to improve the percentage of patients who receive basic screenings.
Value-Based Performance Garners Rewards
By documenting and treating patients proactively, we achieved one of the top scores in the nation in the Medicare Care Management Performance (MCMP) report from the Centers for Medicare & Medicaid Services (CMS). We generated reports on our patients in the areas of congestive heart failure, cardiovascular disease, diabetes and preventive health.
Using PPRNet we exported data into a reporting tool for the demonstration project showing:
These successes led to a top score from CMS and $75,000 in pay-for-performance dollars for our practice. In addition, we recently brought osteoporosis checks into our clinic and increased bone density scanning rates from 25% to 95% for patients over 65 and at risk. This netted an additional $50,000 in reimbursements.
As Medicare payments have declined, we have focused on other services such as wellness physicals. This annual exam is reimbursed at a higher level than an office visit — typically $150 to $200. We now track more than 3,000 eligible patients to ensure that they receive the exams when needed. By incorporating one to two of these checks in our office routine each day we have improved care while capturing revenue that might otherwise be lost.
PPRNet has also helped us to achieve certification as a Patient-Centered Medical Home (PCMH). This approach enables us to provide more personalized and effective care by creating an ongoing relationship between patient and physician. It also ensures that our office staff is more tightly integrated into care of the patient.
Networking and Knowledge Can Improve Practice
Our affiliation with PPRNet has opened up rich opportunities for knowledge and networking with other physicians who are also deep into the transition to electronic health records. At our annual meeting, we share best practices such as how to achieve Patient-Centered Medical Home (PCHM) certification. We also learn how to use patient data to achieve meaningful use and improvements in care delivery that help us qualify for incentive payments available through Medicare and Medicaid.
For physicians, electronic health records offer great opportunities for not only improving patient care, but finding new sources of revenue in an ever-tightening healthcare marketplace. Achieving these goals requires that we take the time to understand how the technology works and how to get the most from its functionality. It also demands being knowledgeable about reimbursable procedures. Otherwise, you and your patients will miss opportunities that can benefit you both.
Robert Cowherd is director of the Cowherd Family Medical Center in Heber Springs, Ark. He practices with his wife, Kristy Cowherd, MD. He earned the doctor of medicine degree from the University of Arkansas for Medical Sciences in 2000. There he became only the second person to complete the combined MD/PhD program.
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