econ_paper_bhatt
TRANSCRIPT
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Running Head: Cost-benefit Analysis of Electronic Health Records
Cost-benefit Analysis of Electronic Health Records in Small Group Practices
Health Care Economics and policy
MHA 644
March 22, 2009
Bilal A. Bhatt
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Abstract
There is increase in the number of physician offices and small group practices that are
installing Electronic health record systems designed for use in ambulatory care settings.
The purpose of this paper is to examine whether an introduction of Electronic Health
Record (EHR) is beneficial and effective in small group practices. Research has shown
that the initial average cost of is $44,000 per full-time-equivalent provider, and ongoing
average cost is $8,500 per provider per year. The average practice paid for its EHR costs
in 2.5 years and after that they get profited handsomely. Electronic Health Records have
the potential to greatly improve quality, although not much is known about their costs
and benefits in small group practices, where more than two-thirds of physicians work.
Large employers and the centers for Medicare and Medicaid services (CMS) are
promoting EHR adoption and are considering programs to help finance the cost or to
provide financial incentives for implementing EHRs.
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Background
The health records contain documentation of patient care activities and health services.
For patients, it serves as a communication tool among care providers. The health record
serves an archival function, pending a need to access the data in future episodes of care.
The information maintained in health records is an invaluable resource for research and
supports claims filed by providers for reimbursement. It is also used for clinical and
administrative performance management activities which improves the quality of care
and improving resource allocation and utilization and cost containment.
A 1991 report by institute of medicine provided major impetus to the development of
EHRs by all health care organizations, from large medical centers to small group
physician offices. A revised report released in 1997 provided an update on available
technology and discussed issues like privacy and confidentiality of electronic health
information.
Electronic Health Records have the potential to greatly improve quality of health care,
although not much is known about their costs and benefits in small group practices,
where more than two-thirds of physicians work. The cost-benefit analysis is practical
attempt to ensure optimal choice in the absence of market (Henderson, 2009).There is not
much literature on cost-benefit analysis in small group practices, so they have to face
greater challenges in successfully using EHRs. The policy makers have to rely on
opinions rather than evidences. If the data about cost and benefit would be better, it will
help policy makers to formulate financial and non financial incentives designed to
achieve an acceptable rate of EHR adoption and higher level of quality improvement
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benefits at the lowest possible cost. Research using technology diffusion modeling (Ford
et al.) suggests that diffusion into small practice setting will not be achieved before 2024.
There is an increase in the number of physician offices and small group practices that are
installing electronic health record systems designed for use in ambulatory care settings.
The Medicare and Medicaid Services provide assistance and support to physicians for
implementing EHRs through Medicare Quality Improvement Organization (QIO)
Program
Pros and Cons
The advantages of electronic health records, in terms of electronic storage, accessibility
and availability of information to authorized practitioners, are often combined with
benefits of an EHRs and it includes enhanced access to medical information, greater
efficiency, which will allow continuous data processing and updated information. The
distinct benefit of EHRs over paper health records is the huge potential of cost saving and
centralized administration. In addition to this, EHRs provide single point of access and
thus allow completed and accurate documentation of all clinical details and variances in
treatments. Furthermore, information can be easily sorted or grouped with certain priority
and criteria which can allow practitioners to graph a set of results over time, thus
allowing them to notice the trends that might be vital for special attention or proper care.
According to Powsner and Wyatt (1998), There are total of ten benefits in having an
Electronic Health Record. One of the benefit mentioned before, that is, continuous data
processing, is actually where the data is structured and coded in an unambiguous
structure. Later programs can check and filter the data for errors, as well as summarize
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and interpret data continuously. The other seven benefits are assisted search,
incorporation of electronic data, tailored paper output, patient data confidentiality,
flexible data layout, safer data and legibility of records.
The disadvantages include items like start up cost and training cost, which can be
excessive in small group practices. The learning is substantial and practitioners have to
have literacy in using the system, performance data as well as information retrieval. So
system must be user friendly. Every error on the records can have a major impact as
multiple users can access the record at one point of time. This can lead to system
software and hardware failure and complete system crash that might result in total loss of
Top 10 Benefits, according to a survey of
providers
1 Interoperability with other departmentswithin a facility
2 Quality of care
3 Clinical workflow
4 Medical staffs work efficiency and timemanagement
5 Patient safety
6 Interoperability outside the facility, butstill within the healthcare system
7 Patient privacy and confidentiality
8 Business practices (strategic andoperations)
9 Patient-doctor relationship
10 Cost of care
Source: Thakkar and Davis. (2006). Risks,Barriers, and Benefits of EHR Systems: AComparative Study Based on Size of Hospital.Perspectives in Health Information Management,3:5.
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data and several weeks of providing care with no computer access and paper charts. The
other risks include financial risk, other than long payback period, severe billing problems
partly related to EHR and redo billing. Lastly, the security measures has to be enforced
strictly to protect privacy and confidentiality in the system.
Top 10 Barriers, according to a survey of
providers
1 Software cost
2 Hardware cost
3 Participation from physicians
4 Interoperability among different electronic
systems and the true EHR system5 Inability to find the software that meets the
requirements of the true EHR system
6 Organizational culture
7 Participation from nursing staff
8 Standards
9 Return on Investment (ROI)
10 Personnel costs
Source: Thakkar and Davis. (2006). Risks, Barriers, andBenefits of EHR Systems: A Comparative Study Based on Sizeof Hospital. Perspectives in Health Information Management,3:5.
In-depth Analysis
The decision to implement electronic health records in any health care setting requires
thorough understanding of the potential cost-benefit and cost-effectiveness. Cost-benefit
analysis requires that all benefits and costs be valued in monetary terms (Henderson,
2009). The cost-effective analysis is a way to quantify trade-offs between resources used
and health outcome achieved without having to value health outcome in monetary terms
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(Henderson, 2009). The study done by Miller et al. on fourteen small group practices,
who used EHR for more than two years on an average, determine the costs and benefits
of EHRs in current early adopter solo or small primary care group practices. All these
small group practices used EHR for most common tasks, including prescribing,
documenting, viewing, and within-practice messaging, and all used it to assist in billing.
According to this study the initial EHR costs were $44,000 per FTE provider per year,
and ongoing costs were about $8,500 per FTE provider per year. Variation in financial
costs were due to heterogeneity among small practices in pre-EHR hardware and in
technical and negotiating skill. Software, training, and installation costs averages $22,038
per FTE provider. Hardware costs average almost $13,000 per FTE provider. Revenue
losses from reduced visits during training and implementation averages $7,473 per FTE
provider. Losses depend in part on the extent to which providers worked longer hours
initially instead of reducing patient visits. Estimated ongoing cost averages 19.5 percent
of initial cost which is mainly due to vendor software maintenance and support fees,
hardware replacement and payment for information staff or external contractors, which
account for 91 percent of these costs.
Financial benefits average approximately $33,000 per FTE provider per year. The
financial benefits for providers are obtained from two main sources: higher coding
levels and efficiency-related savings or revenue gains. Efficiency in economics measures
how well resources are being used to promote social welfare (Henderson, 2009).
Increased coding levels account for more than half of financial benefits. Efficiency
related savings (40 percent of benefits) consists mostly of a decrease in personnel costs.
Efficiency related revenue gains from increased visits accounts for 8.1 percent of
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financial benefits. Other financial benefits are pay-for-performance rewards from health
plans for quality improvement and transcription saving.
The breakeven point for small group practice for its initial and cumulative ongoing EHR
costs is almost two and a half years and then they began to reap more than $23,000 in net
benefits per FTE provider per year. Other benefits include improved quality of life as
providers liked accessing records from home, which enables them to spend time with
family and then work later in evening and accessing records immediately when on call.
EHR use confers various quality benefits, such as improved data organization,
accessibility, and legibility. And almost all practices engaged in specific EHR activities
result in Quality improvement.
Specific Impact
EHRs financial cost and benefits in small group practices can have specific impact on the
rate at which providers adopt them and on the other hand quality improvement benefits
can affect patients health. This in turn then result in financial benefit to payers from
avoiding downstream expenditures, especially for hospital and emergency room
services. Different stakeholders can interpret the results of implementing EHR
differently. From providers perspective, one of the most important impact of EHRs is the
gains from higher coding levels which will reward providers initial time cost and
financial risk taking for EHR implementation. The corrected flaws in a reimbursement
system that encourage providers to code conservatively (under code) out of concern for
fraud and abuse penalties result in further gains. In contrast, from payers perspective,
providers achieved inefficient quality improvement (QI) since payers paid much more for
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very modest QI gains. Furthermore, small group practices could generate the average
gains in each financial benefit category by increasing coding levels for approximately 15
percent of visits, eliminating 0.25 of an FTE medical records staffer, eliminating
transcription, and having 1 percent more patient visits.
Future
From the research I conducted and, I would say that with the diffusion of EHRs in small
group practices, the health care would improve from all the corners. As discussed above
EHRs are both cost-beneficial in terms of monetary gains and cost-effective in terms of
better health outcome. It would be the promising long term investment. I could see EHRs
strengthening all the pillars of healthcare like access, cost, and quality (Henderson 2009).
Government also has envisioned the same and that is the reason why major junk of
Obamas stimulus plan will go to Health care IT. Not only this, several purchasers of
health care, including some large employers and the Centers for Medicare and Medicaid
services (CMS) are considering programs to help finance the cost or to provide financial
incentives for implementing EHRs. Medicare Quality Improvement Organizations
(QIOs) have launched Doctors Office Quality Information Technology (DOQ-IT)
programs, which have begun to provide a range of support service to various layers of
EHR adopters, considerers, implementers, and users. Funding for more rapid expansion
of regional health information organizations (RHIOs) and other entities that can enable
electronic clinical data exchange, ordering, and messaging would especially benefit small
group practices with EHRs by decreasing cost of document scanning, data entry and
providers time to access information.
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The wall mart has moved step ahead and plans to provide package deal for EHRs which
include hardware, software, installation, maintenance and training made available this
spring. This will make EHRs more accessible and affordable. It will cost under $25,000
for first physician in a practice and about $10,000 for each additional doctor. After the
installation and training, continuing annual cost for maintenance and support will be
$4000 to $6500 a year. In the end I would say that EHRs could revolutionize the health
care, but it needs proper handling and regulation as far as patient security and
confidentiality is concerned. So in future there should be more secure and HIPAA
compliant EHR.
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References:
Henderson, J.W. (2009). Health Economics and Policy (4th Edition). Mason, OH: SouthWestern Cengage Learning.
Austin, Charles J., Boxerman, Stuart B.(2008); Information Systems for HealthcareManagement 7th Edition; Health Administration Press.
Lohar, S. (2009). Wal-Mart Plans to Market Digital Health Records System. RetrievedMarch 20, 2009 from http://www.nytimes.com/2009/03/11/business/11record.html?_r=1
Miller, R.H., West, C., Brown, T.M., Sim, I., Ganchoff, C. (2005). The Value Of
Electronic Health Records In Solo Or Small Group Practices. Retrieved March 20, 2009from http://content.healthaffairs.org/cgi/content/full/24/5/1127
Aziz, H. (2008). Cost/Benefit Analysis of Electronic Health Records. Retrieved March20, 2009 from http://knol.google.com/k/hazman-aziz/costbenefit-analysis-of-electronic/27xp34r76wssx/3?locale=en#
Gans, D., Kralewski, J., Hammons, T., Dowd, Bryan. (2005). Medical Groups AdoptionOf Electronic Health Records And Information Systems. Retrieved March 20, 2009 fromhttp://content.healthaffairs.org/cgi/content/full/24/5/1323
Doubert, A., Formoso, A. (2008). A Tutorial About the Costs, Barriers and Benefits ofElectronic Health Records System. Retrieved March 23, 2009 fromhttp://gunston.gmu.edu/healthscience/740/Tutorials/CostBenefitsEHR.doc
http://www.nytimes.com/2009/03/11/business/11record.html?_r=1http://content.healthaffairs.org/cgi/content/full/24/5/1127http://knol.google.com/k/hazman-aziz/costbenefit-analysis-of-electronic/27xp34r76wssx/3?locale=en#http://knol.google.com/k/hazman-aziz/costbenefit-analysis-of-electronic/27xp34r76wssx/3?locale=en#http://content.healthaffairs.org/cgi/content/full/24/5/1323http://gunston.gmu.edu/healthscience/740/Tutorials/CostBenefitsEHR.dochttp://www.nytimes.com/2009/03/11/business/11record.html?_r=1http://content.healthaffairs.org/cgi/content/full/24/5/1127http://knol.google.com/k/hazman-aziz/costbenefit-analysis-of-electronic/27xp34r76wssx/3?locale=en#http://knol.google.com/k/hazman-aziz/costbenefit-analysis-of-electronic/27xp34r76wssx/3?locale=en#http://content.healthaffairs.org/cgi/content/full/24/5/1323http://gunston.gmu.edu/healthscience/740/Tutorials/CostBenefitsEHR.doc