Rethinking the EHR in 5 areas

Much has been said and written about the more than $1 billion in EHR incentive payments the government has infused into the eligible provider (EP) ecosystem. For some EPs, there's no turning back after making the decision to "meaningfully" use EHR systems. However, others continue to hold back, believing the cost of IT and the changes it means for a doctor's practice could outweigh the benefits of potential HITECH Act stimulus funds.

"It seems like a lot of new work for little, if any, actual gain," said Steve Ferguson, patient management officer at Hello Health. "So here’s an idea: Instead of, or in addition to, chasing meaningful use [MU] money, what if doctors started re-thinking how they do business on a very basic level? And rather than re-invent the wheel, what if they borrowed aspects of the very successful lawyer model?"

"What if doctors in primary care adopted aspects of the lawyer business model?" Ferguson continued. "What if they charged for access to information -- or at least the time their staff put into providing that information? What if doctors turned their charts into a revenue center?"

Ferguson outlined five areas in which a lawyer-like business model should merit consideration.

1. It's about finding the ROI on the ROI. According to Ferguson, the first "ROI" means release of information, and "is a great little unexploited aspect of primary care," he said. "The second ROI is the more popular, almost mythical concept of return on investment – mythical, at least when doctors in small practices embark on the path of acquiring an EHR." But, he added, the issue is, it doesn't exist. "It's like the Loch Ness monster of practice financials, unless, of course, doctors begin to think like lawyers."

2. Doctors need to adopt a lawyer-like mindset. Primary care doctors, said Ferguson, should consider setting up a protocol within their practice that requires staff to manage all requests for information like a lawyer. "Run these requests through the practice management, accounts receivable, or even EMR system," he said. Set fees for each type of request, based on what sort of entity is making the requisition. "For example, a life insurance company needs a patient chart to process a claim? $100," he said. "A lawyer needs files for a case? $200. A specialist needs the last three years of labs for a new patient referral? $50. You get the idea."

3. Education is key for all parties involved. "Generate invoices, no freebies, be organized, and be professional," said Ferguson. Doctors need to educate their staff as well to get them to buy in. "They must educate their referral network at the same time," he said. "Explain to them that this is how they roll now. Why not? The lawyer doesn't blink an eye." If transacting like this is out of a doctor's comfort zone, Ferguson added, he/she should try working with a company that offers this sort of service.

4. Doctors need to know that if they're going to charge, they have to deliver value. The practice does have to be professional about this, said Ferguson. "If doctors are going to charge, they must deliver value." And how is value delivered? According to Ferguson, the practice must be set up in such a way that staff can capture and process incoming requests. "An Excel spreadsheet could do the trick initially," he said. "Generate a payment system and send an invoice. And, most importantly, deliver the chart in a professional, timely, organized manner."

5. It's critical to think beyond meaningful use. "Doctors in primary care must think beyond meaningful use when they assess ways to increase their practices’ top-line revenue," said Ferguson. Doctors' charts are the result of hard work, he said, and they're entitled to realize the value they and their staff have created. "Now’s the time to get paid for producing the organized legal record that doctors have taken the trouble to generate and their staff have taken the time to find, organize and deliver," he said. "Do law schools and medicals schools teach Business 101? I don’t know, but it’s obvious the lawyers aren’t shy to charge for their time. Doctors must do the same. They’re worth it."