Wednesday, March 6, 2013
QD: News Every Day--
EHRs: Doctors find it tough to profit, easy to lose satisfaction
The average doctor lost nearly $44,000 over five years after installing an electronic health record system (EHR), a pilot study showed. One in four practices had a positive return on investment, and nearly one in eight would get a positive return had they received the federal meaningful use incentive.
Researchers also noted that half the practices continued to use paper records and didn't net any savings there.
Researchers looked at 49 community practices in the Massachusetts eHealth Collaborative, in which more than 80 ambulatory care practices in three diverse communities agreed to adopt EHRs simultaneously in 2004 under the leadership of the American College of Physicians and the Massachusetts Medical Society. The Collaborative paid the cost of each practice's system, employed consultants to help with implementation, and assisted with vendor selection and contract negotiation.
Results appeared in Health Affairs.
The largest difference in whether a practice gained or lost their return on investment was the extent to which they used their EHRs to increase revenue, primarily by seeing more patients per day or by improving billing for fewer rejected claims and more accurate coding.
Financial "winners" increased revenue by more than $100,000 per physician on average compared to "losers," the researchers noted. One in 10 practices saw more patients per day through improved efficiency. Almost twice as many increased revenue with better coding. "This finding, however, highlights the potential misalignment between optimal provider use of EHRs and the savings that policy makers hope will result from greater EHR adoption, underscoring the recent concern about the potential for EHRs to drive up health care costs," the authors wrote.
Meanwhile, usability ratings for certified EHRs have decreased since 2010, with user satisfaction falling 12% in the past two years, while ""very dissatisfied" users rose 10%.
The American College of Physicians surveyed nearly 4,300 responses to multiple surveys from March 2010 to December 2012. Most doctors were in practices of 10 or fewer physicians, and 82% intend to participate in meaningful use incentive programs.
Additional key findings from the surveys include:
--The percentage of clinicians who would not recommend their EHR to a colleague increased from 24% in 2010 to 39% in 2012.
--Clinicians who were "very satisfied" with the ability for their EHR to improve care dropped by 6% compared to 2010. Primary care physicians were more satisfied than medical subspecialists.)
--34% of users were "very dissatisfied" with the ability of their EHR to decrease workload, an increase from 19% in 2010.
--Survey responses also indicated that it is becoming more difficult to return to pre-EHR implementation productivity. In 2012, 32% of the responders had not returned to normal productivity compared to 20% in 2010.
--Dissatisfaction with ease of use increased from 23% in 2010 to 37% in 2012, while satisfaction with ease of use dropped from 61 to 48%.
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Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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