ORLANDO HEART SPECIALISTS

Cardiology has gone through a rough patch over the past few years: third-party reimbursement for procedures and tests has dropped about 40 percent. Yet Orlando Heart Specialists (OHS), an 11-provider cardiology practice, has maintained its revenues and is very solid financially, says practice administrator Christi Hudiburg.

She attributes much of this financial success, as well as improvements in the quality of care, to the eMDs electronic health record system that OHS implemented in 2008. The EHR has enabled the practice to reduce its staffing, increase collections, and cut days in A/R while improving documentation and coding to maximize revenues.

In the past four years, OHS has increased its number of providers from five physicians and two mid-level practitioners to seven doctors and four mid-levels. But, largely because of the efficiencies made possible by eMDs, its workforce has dropped from 65 to 51 staff members, essentially doubling staff productivity.

WINNING AWARDS FOR PATIENT CARE

OHS’ remaining employees are “actually happier than they were,” Hudiburg said. “When I got here four years ago, everyone felt stressed out and overworked. Now the rapport around the office is much better.” Founded in 1997, Orlando Heart Specialists is a full-service cardiovascular practice with nuclear and echo labs and a vascular center. The practice provides a wide range of cardiac tests, and its physicians perform procedures involving stents, pacemakers, defibrillators, and valve replacements, as well as vascular surgery.

WHY PAPER CHARTS WENT AWAY

While OHS always provided first-rate care, the paper charting system it once used hampered its providers’ pursuit of excellence. “Sometimes, charts could not be found, either because they were misfiled or were in the trunks of doctors’ cars, “Hudiburg recalls. Doctors could not always find lab results; often, they didn’t know whether they had come back from the lab. And when physicians were traveling among the practice’s seven offices, they didn’t always have access to patient records when they needed them.

In 2005, OHS decided to get an EHR. It selected eMDs because of the system’s functionality, customizability, and good value when compared to competing systems.

Using the cardiology templates that eMDs had already created, Hudiburg, then a consultant to OHS, and Dr. Babak Vakili, the group’s most tech-savvy physician, worked with eMDs to build templates for the nuclear and echo labs and the group’s procedures. Meanwhile, they obtained interfaces to their outside reference labs and trained the physicians and staff on the customized system.

In January 2006, the entire group went live on eMDs the same day. “They did not cut their schedules, and they did remarkably well,” Hudiburg recalls.

Just how well they did is shown by the fact that OHS’ providers lost no productivity during the first year they were on eMDs. Thorough training and customization were major factors in this success, she says. “The physicians here took the time to make sure the system met their needs and built the cardiac templates into it.”

In addition, she notes, eMDs is very intuitive and easy to use, compared to some other EHRs designed for cardiology. “If you understand Windows, you can understand eMDs.”

TECHNOLOGY MAKES A DIFFERENCE

eMDs has greatly improved OHS’ clinical workflow. For example, Hudiburg notes, the EHR’s internal messaging function has enabled staff members to have immediate access to each other and to providers across the group’s seven offices. “If a doctor is in the Apopka office and a patient calls us in Altamonte Springs, we can immediately message his nurse and get a message to him right then and there and have the patients’ questions taken care of.”

eMDs also gives physicians access to their charts wherever they may happen to be.

“That’s critical for us,” Hudiburg observes. “Say a patient is down in our Orlando office and starts having palpitations. With a paper charting system, we wouldn’t have a chart down there. But since we have an EHR, we can pull it up at any of our locations. Our docs can even pull it up from home if they get a call from the answering service and the patient is having critical issues at home.”

The EHR also facilitates communications with referring doctors. “The minute the patient leaves our office, we send the referring doctor a copy of the visit note and a copy of the test results,” she points out. Most of these notes go by fax today, but eMDs gives OHS the capability to send clinical summaries online to other practices.

MORE APPROPRIATE CODING

Meanwhile, eMDs has significantly improved OHS’ charge capture and coding, says Hudiburg. One reason for the improved coding is that she uses eMDs as a tool to educate physicians about how to code appropriately. And, because documentation is better, she says, it’s much easier to justify E&M codes. “If the insurance company wants documentation on a level 4 or 5 visit, I have it, and I can argue it and get paid.”

OHS switched to eMDs’ integrated practice management system at the same time that it went live on the EHR, and its performance has been superior. Hudiburg says. “As a certified coder, I love the practice management system. Our A/R is among the top performers nationally, and we’ve been able to keep our days in A/R lower and our collection cost lower than the national average,” she notes, citing data from the Medical Group Management Association.

The group considered outsourcing its billing, she adds, but decided that it didn’t make economic sense. Outsourcing would have cost OHS 2 to 3 percent of its collections, whereas the internal billing operation using eMDs costs only 1 percent.

ACHIEVING QUALITY AND ROI

eMDs also helped the practice reduce overhead. The group’s rapid implementation of the EHR allowed Hudiburg to reduce medical records staffing. After the relevant paper charts had been scanned in, most of that work went away as well, she recalls. When patients come in with notes from other physicians, they are scanned into eMDs by medical assistants as part of their daily workflow.

The practice is taking advantage of Meaningful Use. They have also been recognized for their quality, including receiving Bridges to Excellence® recognition for cardiac care, and also a Florida Health Care Community Quality Award.

OHS more than recouped its investment in eMDs in the first year after it was implemented, Hudiburg states. Since then, the practice has continued using the EHR to keep its overhead low and its quality high, attracting additional business and raising collections to make up for the reimbursement cuts.

“We’ve maintained our revenue while everybody else is going under and being sold to hospitals and closing their doors,” she notes. “Because of eMDs, we’ve been able to stay not just financially viable but very healthy.”

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