Less Is More

Clearly, many practices have reaped the benefits of EMRs, and Southeast texas medical associates is no exception.

To wit: they've saved more than $340,000 in transcription costs, added more than $150,000 in billable charges thanks to improved E&M coding, and increased collections by more than $1.2 million a year.

But where they've turbocharged their use of electronic records is in managing patients with chronic diseases.

James Holly, MD, worked with his IT department to build a standard order set for hospital admission orders, modifiable by the physician, that works in concert with the patient's history and physical exam, which is completed in the electronic record. The practice also uses some 20 disease management tools to track and care for patients with chest pain, pneumonia, asthma and COPD exacerbation, heart failure, and diabetes.

When Holly realized how many of the practice's patients were pre-diabetic, he developed a tool known as LESS (Lose weight,
Exercise, Stop smoking), where at every visit, these patients are weighed and their body fat composition checked; they are given literature and a frank discussion about how to reach their goals. It's a no-nonsense approach, and the practice has gone so far as to dismiss a patient who refused to quit smoking.

The staff had its own incentive to get patients on board with LESS, with a $250 bonus if 95 percent of patients got the LESS treatment in a three-month period. The IT department's monitoring process revealed an impressive 98 percent had.

"It has become a huge tool for us simply because if you look at the patients who have certain disease states, you will find that in almost 90 percent of cases, losing weight, exercise, and stopping smoking are three things that all these patients would benefit from," says practice administrator Richard Bryant.

"We are having better outcomes. We have patients that are, for the first time in their life ... thinking seriously about their healthcare," says Holly. He adds that the practice is 100 percent compliant with all HEDIS criteria, and through its IPA is currently being paid for quality indicators.

Handling High Volume

The practice puts the same high-level effort toward office operations as it does ensuring quality patient care. Two-way radios facilitate speedy communication between the front and back offices without tying up a phone line - a huge plus for a practice that fields 3,000 phone calls a day. SETMA's standard is "every call from every patient answered every day," and the practice has met the challenge. Each call is documented electronically with time and date, who called, the reason for the call, and the response. All of it is stored in the EMR, which is by NextGen.

To accommodate volume, there are separate departments for appointment scheduling and referrals. "One of the beauties of the EMR" is that it includes a referral template, says Bryant. Physicians can enter the necessary information on their screens, hit a submit button, and then the appropriate staff can access it to verify insurance coverage, obtain authorization numbers, and notify patients of appointments once they're scheduled.

Two staff members are dedicated to handling the 250+ refill requests per day. A computerized fax system eliminates the need for thousands of pieces of paper, and a quick check of the EMR's "medication profile" section allows the staff to verify which prescriptions can and can't be refilled.

Recently, SETMA increased office hours by 30 minutes Monday through Thursday, cut back to a half-day on Friday, and added a
Saturday clinic at one location. The result? An increase in patient visits and elimination of 180 hours of overtime ... which the practice estimates will save over $250,000 a year in labor costs. 

- Abigail Green

This article originally appeared in the November/December 2005 issue of Physicians Practice.