Even with government Meaningful Use (MU) payments, small practices are finding it hard to get any return on their investment from their EHR systems. However, with the right steps, it’s possible for practices to achieve a return on investment (ROI).

The traditional sources of ROI are increased efficiency and higher charges based on better documentation. Using an EHR to increase efficiency can require major changes in office processes, and the government has recently increased its inquiry into documentation techniques that help practices justify charging more. As a result, not many small practices can achieve ROI on their EHRs through fee-for-service based reimbursement.

These models include: ACOs that participate in shared savings programs, Patient-centered Medical Homes that many insurers incentivize, and pay-for-performance programs that pay quality bonuses. To varying extents, all of these models require the use of EHRs. Therefore, the lack of an EHR represents an “opportunity cost” that can be weighed against the cost of installing a system. Most practices are still receiving very little income from value-based reimbursement, but ACOs and medical homes are increasing. Some physicians are beginning to see the possibility of achieving ROI.

While it’s still possible to get ROI from a combination of MU incentives, efficiency, and higher charges, it’s becoming more difficult. Process redesign is crucial if practices want to increase efficiency, but because of the MU deadlines, enough time isn’t being taken to implement these systems effectively.

The amount of additional revenue practices can receive by improved coding depends on whether they were under-coding before EHRs. However, even if they could raise their charges by improving documentation, CMS is paying close attention to physicians who copy past notes into current notes or who document by exception. As a result, many physicians are coding more cautiously.

Even without an initial ROI, by participating in the programs and alternative care delivery systems available, EHRs can still be used to generate future revenue.

Author: Lauren Daniels

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