hitc cost budgeting webinar 4.19.12
DESCRIPTION
Learn how to plan a budget effectively and realistically for EHR implementation success.TRANSCRIPT
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The Health Information Technology Community
Electronic Health Record Budgeting
Effective and realistic cost plans for today's implementation and
tomorrow's support and maintenance
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Michael Levinger• President, CEO and Co-founder of The HIT
Community • 30+ years of experience in the successful
use of mission-critical software including EHRs and Health Information Technology
• On the faculty of Boston University teaching a masters degree course on Electronic Health Records
• Serves as the Health IT “Ask the Expert” for Pri-Med
• Member of Massachusetts REC workgroup on Health IT Workforce Development
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Welcome!
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The HIT Community Services
Create and manage online collaboration solutions
Manage public, sponsored nation-wide online communities
Consulting services on communications & collaboration strategies and online social communities & media
Supported by data analytics
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Agenda
• Electronic Health Record Budgeting– Uses of funds– Sources of funds
• Critical Success Factors• Questions & Answers
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• Put in polling question on where attendees are in the EHR deployment process
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EHR BudgetingSources• Government• Provider
Performance• Reimbursement
Uses• Direct• Indirect
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Question
• How many people have a program budget already?
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EHR Deployment Resources
• People• Software• Hardware• Telecommunication• Services
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EHR Deployment Resources
• People• Software• Hardware• Telecommunication• Services
• Clinical Staff• Administrative Staff• Software Expertise• Hardware Expertise• Project Management
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EHR Deployment Resources
• People• Software• Hardware• Telecommunication• Services
• Electronic Health Record• HIE• Operating Systems• Security• Virus/Threat• Utilities
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EHR Deployment Resources
• People• Software• Hardware• Telecommunication• Services
• PC’s• Mobile – Tablets, PDAs, etc.• Servers• Telecommunication – Routers,
Modems, etc.• Security• Medical Devices & Connectivity
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EHR Deployment Resources
• People• Software• Hardware• Telecommunication• Services
• Bandwidth• High-capacity• Backup
• Voice• Data• Image
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EHR Deployment Resources
• People• Software• Hardware• Telecommunication• Services
• Hardware Deployment• Software Implementation• Physical Site Preparation• Project Management• Process Re-design• Training• Support
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Potential hidden costs of EHR
• Impact to workflow and patient capacity • Impact to revenues• Hassle factor• Staff impact• Cost/benefit
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ARRA Incentives - Just the tip of the $$ iceberg
• Government incentives• More patients per day • Improved practice efficiency• Practice growth• “Pay for performance “• Better coding performance • Improved contracting
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Question
• How many people feel they know the financial benefits of an EHR?
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As much as $44,000 per provider• Must be eligible professionals (NOT
hospital-based) that are meaningful
EHR users
• Paid over five years
• Disincentives if don’t deploy EHR
system, payments will be cut – 1% in 2015
– 2% in 2016
– 3% in 2017
• Lots of “fine print”
As much as $63,750 per provider• Must be eligible professionals (NOT
hospital-based) that are meaningful EHR users
• Must meet certain Medicaid volume levels
• Payment for up to six years• Up to 85% of the costs for certified
EHR technology and support services• Some pediatricians can receive up to
$42,500 at lower thresholds• Maximum of $21,250 in the first year,
$8,500 in subsequent years, up to a total of $63,750.over total time frame
• No payments after 2021
Government ARRA Incentives for EHR implementation
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More patients/day• Basic truth: the longer it takes to document a visit, the less money
you make!!• Example:
– Work from 8-5, see 24 patients, Average $70/patient = $1680/day– 3 minutes per patient to document = 72 minutes– 2 minutes per patient= 48 minutes– 1 minute per patient= 24 minutes
• If documentation can be reduced from 3 minutes to 1 minute..– you could see 2 more patients/day– = 10 patients/ week– = $700/week– = ~ $30,000/year
BUT – what if documentation time increases?
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Improved Practice Efficiency
• Decreased transcription costs• Decreased billing/coding costs• Decreased admin process costs
– Managing charts – Filing lab slips, hospital reports etc.– Reduced telephone encounters (more self-serve from
patient portal functionality)
• Opportunity to decrease 1-2 FTEs…$30,000-$50,000
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Practice Growth
• Driven by consumerism in healthcare– Information transparency– Public perception of technical sophistication– Improved convenience– High tolerance for / desire for self service– Cost consciousness on behalf of the patient => cost
transparency
Example: 10-15% increase in patient volume can lead to 10’s of thousands of $$
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Pay for Performance
• More accurate data collection• More reliable data retrieval• More efficient alerting and reminders• Private insurance & Medicare/Medicaid• Potential P4P of $15,000-$40,000 per provider per year
BUT: Can’t get the incentives if can’t document the performance
AND: Capitation/Accountable Care Organizations will have more impact in the future
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Improved coding
• Use of EMR system coding prompts• More confident “upcoding”• Less audit concern
Potential reward….$50,000-$100,000
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Improved Contracting
• More insurance company leverage• More Insurance company responsiveness• Example … $10-$20 per member per month
$20 x 1000 patients x 12 months = $240,000
Done right, you do well – “the new capitation”
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Question
• How many people believe EHR deployment will “make” their practice money?
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So…is EHR adoption worth it?Costs Sources
• Upfront investment
• On-going cost (software, hardware, support)
• Initial lost productivity (converting from paper, physician and staff training)
Total over two years
$40,000-$60,000 one-time
$5,000-$10,000 per year
$50,000-$100,000 one-time
$100,000-$180,000
• Government
• More patients per day
• Improved practice efficiency
• Practice growth
• “Pay for performance “
• Better coding performance
• Improved contracting
Total over two years
$44,000-$63,750 one-time
$15,000-$30,000 per year
$30,000-$50,000 per year
$10,000-$50,000 per year
$15,000-$40,000 per year
$25,000-$100,000 per year
$50,000-$240,000 per year
$334,000-$1,000,000+
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Case Study
Michigan State UniversitySparrow Health System
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MSU Sparrow Case Study
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MSU Sparrow Case Study
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MSU Sparrow Case Study
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MSU Sparrow Case Study
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EHR Budgeting – Success Factors• All benefits must have a baseline and well defined measurement
approaches.• Expense reductions must result in budget reductions to the
appropriate accounts.• Efficiency must show full time equivalent (FTE) reductions or
increased chargeable productivity. • Future FTE cost avoidance is only allowed if the position is
previously approved in a budget and an account's budget can be reduced accordingly.
• Cost avoidance must tie to future expenses that are already contractual bound and budgeted.
• A hurdle rate for return on investment (ROI) will be defined and measured.
Source: http://www.healthcareitnews.com/blog/building-financial-case-electronic-health-records
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Questions?